MYCELLS®: NEW PRP FOR SKIN REJUVENATION AND ANTI-AGING AESTHETIC MARKET RELEASE DURING OCTOBER 2008

The use of PRP to rejuvenate the facial skin and to renew tone and texture, is not new and has been comprehensively described by Professor Robert Marx of Miami University and other workers. A new generation of office-based, easy to use human autologous platelet-rich plasma (PRP), MYCELLS® was released during October 2008. PRP, which is autologous or derived from the same person, is referred to as blood component therapy, rich in platelets and GF soon after activation of the platelets. There are at least 10 systems commercially available to doctors for the generation of platelet rich plasma. Provided the blood specimen is properly handled, all PRP’s are the same. Large studies in man show that the content of PRP is reasonably constant, including platelet count and growth factors such as PDGF and TGF. There is actually very little difference between products. The process of aphaeresis is not used to harvest platelets in the office. Thrombin-buffy-coat based systems are used in most PRP devices and systems, and the fibrin gel-induction is performed with calcium chloride or gluconate. Each device has its curiosity and may differ slightly in centrifuge technique and separation of the PRP. Most important is to avoid iatrogenic contamination of the PRP during the blood collection and separation steps, as emphasized by BOLANDCELL. Most collection tubes have sodium-citrate as anti-coagulant. Rejuvenation of the epidermis after PRP is due to either the needling process, platelet growth-factors or fibronectin in the plasma. The process of PRP-generation is commercially available and functional in aesthetic doctor’s suits for rejuvenation of the face for improved beauty, skin tonification, and as anti-aging therapy. PRP is not a filler, but blood component therapy. The modus operandi for utilization in the beauty and facial rejuvenation by medical health care professionals and aestheticians is explained on the home page. MYCELLS® (www.my-cells.net) and comparable REGENLAB PRP ( www.regenkit.com ) are now both in clinical aesthetic use in selected aesthetic clinics that also specialise in the use of plasma facial resurfacing for regeneration, apart from photofacial PDT, carboxy-therapy, and chemical peels. MYCELLS® which is PRP, differs from the “Isolagen Process” that relies on the transplantation of living and cultured human fibroblasts. PRP contains no fibroblasts of note, but does contain platelets, white-cells, fibronectin and a few RBC’s. Some laboratories offer combined ex-vivo PRP-driven cultured fibroblast cell therapy and PRP at the time of cell delivery and various intervals thereafter to maintain deterioration of the skin and dermis.
REGENLAB PRP®, the market leader, generates PRP for theatres and office use by a patented process, for both clinical therapeutic and aesthetic use, at affordable prices. This entails peripheral venous blood collection in special CE marked tubes, authorised for human use, centrifugation and PRP concentration, by plasma separation. The layer of enriched and purified platelet-rich plasma is isolated (and which contain quantifiable human growth factors such as PDGF, TGF, VEGF, IGF,). In South Africa, PRP is distributed by Omnimed (PTY), (LTD), Randburg, Johannesburg and has a strong academic support base and distribution network, delivering excellent service and after-sales service to medicine, dentistry aesthetics using PRP-biologicals. To-date, REGENLAB PRP, delivers cutting edge biotechnology, proof-of-concept, excellent platelet-yields and growth-factors compared to competitors. It is a leading contender in cell innovation. Cell biology studies utilizing REGENLAB PRP across 5-cell lines relevant to wound healing and care, rejuvenation and regeneration make REGEN PRP the product of choice for the clinician and aesthetician. REGEN PRP is supported by evidence, and proof-of-concept, in-depth studies regarding mechanisms of tissue regeneration, making it the selection of choice, with predictable outcomes in, aesthetic medicine, plastic surgery, maxilla-facial surgery, implant surgery, burns and orthopaedics. The biology behind the success of REGENLAB PRP has recently been confirmed by Japanese academics (see later and reference to PRP and cell culture of fibroblasts).

PRP UPDATE AND NEW RELEASE ON DECLINE IN THE USE OF BIOLOGICALS 2009.
POPULARITY OF PRP ( AUTOLOGOUS PLATELET-RICH PLASMA) FOR FACIAL SKIN-REJUVENATION IN THE SALON  IS DECLINING IN THE EXPANSION ERA OF PEELS, RF, FILLERS AND LIGHT.

Scientifically, the molecular and cellular mechanism of action of PRP in wound healing and tissue regeneration is reasonably well understood and established, but not transferrable to aesthetic, cosmetic, skin -rejuvenation or anti-aging science ( see refs). Robust science in the regenerative, rejuvenation, and cosmetic industry, regarding  biologicals, is vague. And the reason for the detectable decline in the use of biologicals to rejuvenate the face the last few months in 2008, has been troublesome variable or no results reported by some salons, lack of comparative clinical trials.
In the cosmetic business, the most constant marketing focus is change with new ideas appearing on the market each day. Platelet–rich plasma (PRP), introduced recently in the past 4-years for facial rejuvenation or plasma resurfacing with your own cells, by the technique of needle facilitated PRP-mesotherapy has started declining during 2008/9, after initial enthusiasm, because measurable results are slow to show, unsustainable, uncertain client feedback, leaving the client dreaming about possible improvement, and a rapid recurrence of ugly crepe and vertical lines plagued by sagging. It is now becoming clear that PRP is not a general panacea for skin-rejuvenation. PRP is not a filler, compared to other plumping gels, and the PLT-gel is quickly absorbed after injection, leaving an immediate post-procedural puffy-face and peri-orbital regions, lasting up to 12 hours, due to oedema and dermal reaction to the plasma, proteins and growth-factors released by the platelets. Many complain about this down-time.
Only exceptional clients now gain modest benefit from PRP, as seen in interim studies, compared to the recent advances in light, fillers and photofacial therapy. Many recipients of PRP show no result, and so the jury is still out until 2010, as detected in these open-ended salon studies. Much the same as the disappointment with the treatment of facial hyper-pigmentation. Initially the industry was excited with the results of cultured living fibroblasts and PRP during 2007/8, but enthusiasm has waned steadily for biological facial rejuvenation during 2008, as follow-up digital scanning results became known. The cosmetic market for PRP ( 2008/9) is diminishing now, because of inconsistency in achieving non-lasting facial rejuvenation, originally seen, especially around the eyes, short-term inconsistent results, compared to Botox, RF, Laser, LED and photo-facial. Half the claims made about biological skin rejuvenation, simply are not reproducible by all salons, and this has led to a re-think on biologicals. PRP is steadily being superseded by Botox™, Juvederm™ , IPL, RF, LED and chemical exfoliation ( Neostrata™). PRP is unable as stand-alone treatment to ameliorate the following degrees of skin aging ( marked Fitzpatrick and Glocau scores) and add-ons are needed:

SKIN AREAS SLIGHTLY OR MODESTLY RESPONSIVE TO AUTOLOGOUS PRP-MESOTHERAPY OR PRP PLASMA RESURFACING-SKIN REJUVENATION

PRP devices and products available to salons, wellness-houses, and clinics in South Africa during 2008/9 Include: REGENLAB, ™ REGENKIT™, PLATELTEX ™AND MYCELLS™. Addition of cell-therapy with living cultured fibroblasts, that takes weeks to generate, has also proven futile and not cost effective to the client.

PLATELET-RICH PLASMA, FOR FACIAL AND NECK REJUVENATION IS NOW SUPERSEDED BY CHEMICAL FACIAL PEELS AND EXFOLIATION TECHNIQUES, BOTOX™, JUVEDERM™ Filler AND COMPETITORS, to ameliorate facial wrinkles. In some salons autologous platelet-rich plasma or PRP has disappointed after an initial enthusiastic start, and conflicting reports in the literature.

REGENLAB™/REGENKIT™: AVAILABLE PRP DEVICES IN SOUTH AFRICA FROM LOCAL DISTRIBUTORS : THERAPEUTIC AND AESTHETIC MEDICINE (WWW.REGENKIT.COM)

PLATELTEX™ ACT ACTIVATION KIT 0/0: Calcium gluconate, batroxobin. See info@plateltex.com (Brastislava). A venous blood specimen is obtained, then RBC and plasma separation by centrifugation, activation with calcium gluconate and batroxobin for rapid gelation.

MYCELLS™ PLATELET-RICH PLASMA FOR AESTHETIC MEDICINE: Process of PRP generation: SEE www.my-cells.net

PLATELET-RICH PLASMA (PRP, OR AUTOLOGOUS PLATELET-RICH PLASMA): REFERENCES: FOR REGENLAB™/REGENKIT ™AND MYCELLS™.( PLASTIC SURGERY, WOUND CARE, THERAPEUTICS, AESTHETIC , COSMETIC AND BEAUTY, CUTTING EDGE RESEARCH AND DEVELOPMENTS,  APPLICATIONS IN SOUTH AFRICA.

UPDATING: 18 January 2009

SKIN AESTHETIC UPDATE 2008 ON PRP.

PRP has proven effective in plasma resurfacing of the face and facial regeneration, by biostimulation of dermal, epidermal and mesenchymal components and generated by platelet-derived growth factors. The pioneers regarding our understanding of platelet-rich plasma in South Africa are Don du Toit, from Cape Town and Callie Franz from the University of Pretoria. Clearly, PRP is not a filler, but offers some degree of dermal and epidermal rejuvenation. This is not only collagen driven, and some is related to deposition and enrichment of dermatan sulphate. The definitive works have been reported by Marx and co-workers of Miami, USA. Temporary skin oedema after injection usually subsides. Adjuvant treatments such as Botox, superficial chemical peels and LED PDT, performed independently, improve PRP-recipient skin further. Most authorities, schooled in the field, including BOLANDCELL, concede that the facial resurfacing and regeneration effect of PRP, also referred to as autologous cellular regeneration (ACR), rapidly declines after 3 months, necessitating further multimodal anti-aging treatment. Senescence of the resident dermal fibroblasts is responsible for the variable results, described world-wide. PRP-treated skins, affected by solar-ageing, respond by modest collagen deposition which takes up to 100-days to become histologically evident. Elastin repair does not occur, convincingly, and the sagging and jowls persist. There are some clients with solar damage that do not respond to PRP, and a refund is needed. PRP can be delivered either as small injections into the dermis or be delivered by mesogun which works well, although spillage is troublesome. Techniques of mesotherapy have been described by Dr Riekie Smit of Pretoria. These include intra-epidermic, intra-dermal-nappage, subcutaneous and meso-perfusion. Moderate swelling of the face and peri-orbital areas occur after administration of PRP and due to traces and activation of collagenases. In these cases, there may be down-time for a full week (7 days), requiring dark sun-glasses, but resolution is the eventual outcome. The latest advance in facial rejuvenation is needleless PRP-mesotherapy using the EPOREX® device that improves PRP skin absorption after ultrasonic epidermal ablation and electroporation ( Bester Medical Aesthetics, bmed@telksa.net or www. bestermed.co.za: Tel: 021 559 7263). Results are better than when PRP is injected under the skin. Injections may well be something of the past. Rejuvenation of your face with PRP cannot be considered in the presence of fields of growth, or past history of BCC, SCC, or melanoma. Potential PRP-recipients must be seen by a medical doctor, carefully screened with skin analysis to exclude epidermal cancers and solar keratosis. Pre-malignant facial skin disorders must be diagnosed and referred to a dermatologist and plastic surgeon. PRP cannot be used safely in HIV/AIDS patients to correct lipoatrophy, because the platelets are damaged by the virus which leads to thrombocytopaenia.
VIRTUAL PRP MESOTHERAPY NEEDLE-FREE THERAPY BY THE EPOREX® K69 TECHNOLOGY
A new era of needle–free platelet-rich plasma (PRP) mesotherapy, for facial and décolleté skin rejuvenation is now available from November 2008 in the northern suburbs of Bellville, with EPOREX® Technology. The PRP-gel is transferred trans-epidermal by electroporation or electro-permeabilization, via micropores and channels that open and shut momentarily, and facilitated by the EPOREX® DEVICE. The cytokines are transferred to the target areas by new patented technology, without the need for needle injection that has numerous downsides. NEEDLE-FREE or VIRTUAL PRP MESOTHERAPY, is an alternative non-invasive alternative to conventional mesotherapy. Biological cell products, for cells and PRP and technologies available in the RSA include:

The EPOREX®  device, is multi-modal and provides for pre-treatment with ultrasonic skin exfoliation of the target area, before electroporation.
CULTURED HUMAN FIBROBLASTS AND SIMULTANEOUS PRP FACIAL MESOTHERAPY
Combination therapy with cultured cells and PRP may well be excessive biological treatment and over-servicing of clients. Either PRP or cell therapy with cultured fibroblasts is fairly effective in rejuvenation. A combination is not synergistic, very costly and holds risks in for the client. Rejuvenation potential is not increased by the dual approach, and is prohibitively expensive. No laboratories in South Africa can substantiate any claims. There is a lack of published robust science. The downsides of cell manipulation are important to those patients undergoing aesthetic therapy, especially where multiple injections are required over several sessions of treatment ( Bob Kronemyer, www.miinews.com). All these problems can be reduced by the application of needle-free, virtual mesotherapy. Platelet-rich plasma (PRP) has been shown to increase the proliferation of cultured fibroblasts ex vivo, and the earlier observations and papers of BOLAND CELL during 2007, have been confirmed by Japanese academics ( Kakudo et al, Kansai Medical University, Osaka, Japan. Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts: Plast Reconstr Surg 2008: 122;1352-60).

OTHER NEW NATURAL FACE REJUVENATION PRODUCTS

PLAZAN®, produce an excellent Russian-based face mask (MACKA), and other placental rejuvenation products that enhance superficial chemical peels. These products are distributed by Bester Medical Aesthetics in Cape Town ( Tel: 021-5597263) .See illustration below. Peptides in creams regarding facial rejuvenation are very topical these days, and the local products DERMAHEAL® are available ( Lamelle Laboratories, Johannesburg).
REFERENCES RELEVANT TO AESTHETIC PRP-MESOTHERAPY:

Terms and conditions apply. Consult with your doctor before commencing aesthetic treatment, biological manipulations or culture cell- therapy in order to make an informed decision.

 NOVEMBER AESTHETIC LECTURE WORSHOPS IN CAPE TOWN: CPD ACCREDITED

Course Director: Don du Toit, FRCS, PHD., DPHIL(OXON)
Content: Chemistry of carbon dioxide, indications for carboxy therapy, contraindications, side-effects, techniques, skin assessment apparatus and technologies, clinical application, place in the treatment of stretch marks, cellulite, rejuvenation, periorbital rejuvenation, psoriasis, diabetic feet, responders and non-responders
Venue: 15 November 2008 at 8:30am at Besters Medical Aesthetics, Panorama, in Cape Town.

WATCH THIS SPACE FOR FURTHER AESTHETIC WORKSHOPS DURING 2009

WEBSITE POSTING and updating  22 November 2008

Table-1: COSMETIC/AESTHETIC PRP-UPDATE 2010. BIOMEDICAL SCIENCE , CLINICAL AND BASIC SCIENCES REGARDING PLATELET-RICH PLASMA (PRP): After Marx 2005 et al.

PRP releases seven growth-factors (GF) from activated platelets: these GF promote healing and regeneration ( tissue healing and biocellular regeneration).Thus, the GF are relevant to wound-healing PRP is autogenous blood clot and contains concentrated numbers of platelets ( about 4-7 times baseline is needed for clinical benefit) The alpha-granules of the platelet store the GF (PDGF, TGF,VEGF,EGF): GF are proteins and need to be biologically active to work: biological actions: stimulate mesenchymal stem cells and resident adult cells to replicate, osteoblast replication, endothelial cell-replication, fibroblast and osteoblast-replication to produce collagen, enhance bone-regeneration, stimulate matrix-formation, stimulation of pericytes, epidermal-regeneration and re-surfacing PRP is not stem-cell therapy, but is non-invasive and fairly safe PRP does not contain stem cells of any relevance, but may be directed at resident stem cells that are up-regulated after injection to replicate together with other mesenchymal cells The platelet alpha-granules also contain cell-adhesion molecules and involved with vitronectin, fibronectin, fibrin The GF have two active sites each and are called dimers PRP: 94% platelets, 5% RBC, 1% WBC and no stem cells of note Enhancement of autogenous bone-grafts used in maxilla-facial surgery and orthopaedics PRP can be  considered for facial-regeneration /rejuvenation but the effects only last for 6-months and other complimentary treatments such as RF are needed to back-up or bolster the plasma. Stand-alone PRP-treatment is insufficient to reverse or ameliorate ageing and add-ons are needed Enhanced proliferation of skin basal cells ( stem cells of the epithelium): following blood-clot formation (improved donor-site healing  after skin-graft) Enhancement of osteointegration ( relevant to implant-surgery) NB: Poor technique can render poor quality and PRP enrichment: one needs to concentrate viable bioactive platelets. Therefore the best PRP processing device is needed. PRP can be used during stem cell transplantation and the biological action is referred to as: PROLIFERATION-PROMOTING EFFECT (may be used with human adipose-derived stem cells and human dermal-fibroblasts: see Kakudo et al,  Plast Reconstruct Surg 2008: 1352-60). Therefore PRP application can be utilised for cell-based, soft-tissue engineering and wound-healing The topical efficacy, and level - evidence, has been demonstrated in the treatment of diabetic-foot ulceration. Numerous indications for PRP are described in cranio-facial surgery:  bone grafting, rhytidectomy, face-lift, fat-grafting and transfer Potent cell proliferation enhancer ex vivo using fibroblasts, adipose-derived stem cells, keratinocytes Controversial areas: PRP-MESOTHERAPY for facial rejuvenation and repair of solar-aged changes, sagging, wrinkling. The problems include unpredictable inconsistency, poor and no-response in some clients. It is an international experience. This is a feature of biologicals and applies to stem cell application at the time of posting. Need for additional facial back-up RF treatment is mandatory after PRP-MESOTHERAPY to reach benchmark cosmetic-output. Is it not the RF that is working or the PRP? For the moment cosmetic-scientists are not sure if subdermal and subcutaneous injections of PRP are superior to other established cosmetic treatments. Established cosmetic clinics have demonstrated that PRP-FACELIFT is not superior to superficial chemical-peel plus LED, IPL or fractionated laser. BOTOX and fillers are far superior to PRP in gaining quick results. PRP- mesotherapy is far more costly than BOTOX or DYSPORT. PRP is not stem cell therapy and cannot turn back the ageing clock completely. More robust science and evidence is needed. But it seems that PRP may well have a place in the cosmetic armamentarium of the cosmetic surgeon, dermatologist and aesthetic physician. PRP is more established in therapeutics at the clinic but not in the beauty salon. Dermatological or plastic surgery consultation. Such a consultation is essential to assess if you are a suitable client for such treatment References: Marx and Garg 2005, Quintessence; Kumar et al, Robbin’s Basic Pathology, 2007, 8th Edition, International Edition; Du Toit et al, The Specialist Forum 2007:7; 30-31. PRODUCTS AVAILABLE IN RSA:  Regen-PRP® (REGENKIT®) (Cost: R800 per tube); MyCells® (Neokit®) (costs: R1300 per tube).PRP-mesotherapy demonstration of technique is available on the Internet: See U-Tube demos by various doctors. DISCLAIMER: This site provides no medical or cosmetic advice or recommendation and therefore an aesthetic expert should be consulted regarding any facial treatment, treatment choices to the neck, décolleté or dorsal aspects of the hands. Formulation: BIOMED Expert and Specialist. WEBSITE UPGRADING AND UPDATING: 16 November 2009. See BOLAND CELL menu: PRP UPDATE 2010.

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