PLATELET-RICH PLASMA (PRP) AND ACR CAN AMELIORATE FACIAL ACNE SCARRING: NEW ROLE IN BIOLOGICAL REJUVENATION
Platelet-rich plasma (PRP) has been utilized in aesthetic medicine ( UK , Japan , and Asia, Europe ) to rejuvenate and ameliorate the aging process and face ( 2006). This refers to mesenchymal and epithelial rejuvenation by application of the persons own enriched autologous plasma. Treatment of acne scarring is, however, challenging for the aesthetic physician and dermatologist, especially in pigmented races. Current practices include fractional photothermolysis, microdermabrasion, IPL, peels, LED and keratinocyte autologous transplantation. Not all forms of light therapy is safe in pigmented races, blacks and African Asians and the immediate problem is hypo-pigmentation. Recently, PRP/ACR has been pioneered in South Africa during 2006/7 by Professor Donald du Toit, from Cape Town for facial rejuvenation in select patients with chronological aging, and solar damage. Treatment in African Americans and blacks with acne scarring is problematical and long term results cannot, at the time of writing be guaranteed. A clinical case study is included and shows the early end-point analysis of REGENLAB PRP/ACR treatment in a young, black female presenting with unsightly non-responsive acne scarring of the malar regions. The following measured outcomes after 1 month are documented:
- General skin improvement
- Improvement of tone
- Improvement of texture, pigmentation
- Dermal volumetric biological filling
3D restoration of the malar area and focal rejuvenation (see images reflecting skin morphological changes after ACR/PRP treatment with autologous human enriched-plasma. REGENLAB PRP is distributed in South Africa by Omnimed (Pty)., Ltd. Costs are in the range of R5000-R7000 per treatment. Down time is minimal (i.e. usually mild bruising, swelling). Safety profile is good because the patient's autologous (same) plasma is used, but has to be administered by an experienced medically trained practitioner. PRP/ACR together with LED (633 nm) and good quality facial cosmetic creams renders very good results in the medium to long-term. A wide selection is available and include brand names such as NEOSTRATA . PRP kits are available from the South Africa Distributors ( Omnimed Pty Ltd ).
FACIAL REJUVENATION WITH YOUR OWN CELLS AND PLATELET-RICH PLASMA (PRP): STANDARD ORDERS AND PROCEDURES. INFORMATION BROCHURE.
Aging of the human face is a given and something we have to live with. The process is gradual, starting at the age of 25 years and progresses rapidly after 60 years. Most people, of both genders, choose to age gracefully. However, in the era of anti-aging medicine, the tendency is to turn back the clock and undergo some form of rejuvenation to reduce facial wrinkles, lines and blemishes. For decades, rejuvenation of the face by surgical face-lift has been popular. Today, more non-invasive treatments are available to improve the skin complexion of the aging face. This is because people want to look better with as little as possible down time and morbidity. Although a quick-fix is not possible for ugly wrinkles, there are newer treatment options available to ameliorate aging aspects that affect the face, neck, décolleté and the back of the hands. For decades the backbone of facial rejuvenation has been massage, facials, and cosmoceuticals including moisturisers, sunscreens, micro-dermabrasion, serums and foundation cosmetics. Botulinum and fillers have also become popular. Currently, popular methods to rejuvenate, tighten and resurface the face include radiofrequency, non-ablative photothermolysis, IPL's and light-emitting diode (LED) phototherapy. Also popular is combination therapy consisting of IPL, laser and cosmoceuticals, including vitamin A derivatives. However whatever option is used, the aging process cannot be prevented and skin improvement by these treatments is gradual, subtle, modest and variable. Avoidance of excessive sunlight is important to prevent accelerated photo-aging, blotches, lentigenes and skin cancer. A new approach, appealing to clients seeking a more natural approach to facial rejuvenation, is rejuvenation with your own cells and more specifically, autologous platelet-rich plasma (PRP ). This is also referred to as autologous cellular regeneration ( ACR) an aesthetic practise, is a safe and tolerable procedure.
Aging of the skin, dermal components and cells, means that the skin texture and appearance deteriorate. Aging affects the hands and soft tissue of the face. This is characterised by sagging, jowls, thinning of the skin, puffiness, age spots (lentigenes) and wrinkling (forehead, cheeks, neck and décolleté). Skin texture changes and dryness is problematical. Sun exposure worsens the process by solar-aging and UV irradiation. This means that vertical and horizontal crepe lines deteriorate with time.
SKIN ANALYSIS: IMPERATIVE BEFORE STARTING THE REJUVENATION PROCESS
Ask your aesthetic therapist to perform a skin analysis and to grade the aging process. Scoring is done by using the Fitzpatrick scale, analysis include assessment of the skin tone, colour and texture. Damage can be quantified by photography, scanning and ultrasound ( Dermascan or Visia ). Treatment options are then based on this analysis, and only after the client has given informed consent, allowing for realistic aspirations.
PLATELET-RICH PLASMA (PRP): YOUR OWN ENRICHED PLASMA
Science supports the use of PRP for the augmentation and regeneration of hard and soft tissues. PRP or blood plasma is the source of concentrated platelet content present in blood. Apart from assisting blood clotting, platelets also release growth factors that assist the human body to repair itself by stimulating cells to regenerate new tissue. Today, platelet rich plasma can easily be separated from blood, through a process of centrifugation. Using your enriched plasma permits the body to heal faster and more efficiently. Because your plasma (autologous) is used, there is no danger of disease transmission, anaphylaxis or neoplasia. In general medicine, platelet transfusion is common practise in treating blood platelet disorders, including very low counts associated with bleeding.
PRP IN AESTHETIC MEDICINE AS ANTI-AGING TREATMENT
Case studies reported in Europe, England , Asia, Japan and South Africa have demonstrated consistent rejuvenation of facial aging, including wrinkling in persons with modest grades of photo- or chronological aging. Patient selection is important and skin diseases have to be excluded. Improvement of skin texture and tone can be expected, these features are noticeable within 3 weeks, and the process can be enhanced by addition of appropriate cosmoceuticals. Benefits include non-allergenic properties and ease of administration.
PROCESS OF FACIAL REJUVENATION BY PRP AND ACR
- Your therapist will assess the degree of skin aging, perform a skin analysis, and recommend a sensible treatment with reasonable outcome.
- For the PRP/ACR treatment your therapist must be adequately trained. It is your right to ask him/her. An appropriate therapist must be medically qualified or be a registered homeopathic practitioner.
- Options of facial rejuvenation are explained to you, including efficacy and safety. Cost analysis is discussed and the number of sessions possibly required.
- Persons between the ages of 30 and 80 years are eligible.
- Almost all skin tones show that the process is safe and effective because your own enriched plasma is used, but not all grades of wrinkling can be reversed or ameliorated.
- A photograph of the skin is taken to assist the follow-up and grading of the improvement.
- Sixteen millilitres (16ml) of blood is obtained from the arm by venapuncture.
- The blood is collected in special sterile tubes and centrifuged in the practitioner's rooms to separate the plasma. The plasma is drawn up into a syringe and activated with calcium-chloride; this stimulates natural growth factor release from the platelets in the plasma. About 8ml of PRP is obtained which is used for facial rejuvenation and injection.
- By a mesotherapy technique, the PRP is injected, by multiple tiny punctures under the skin (including the dermis), under topical local anaesthesia. The forehead, peri-orbital region, cheeks, chin and dorsum of the hands, are the targets of aging and wrinkles, for rejuvenation. The process is relatively painless providing sufficient topical anaesthesia is applied. A mesotherapy gun is also suitable to deliver the PRP into the skin and the dermis.
- The process takes about an hour, is done in the practitioner's rooms and the down time is minimal.
- PRP facial rejuvenation (or also termed ACR ) is a one off treatment, but further microinjections can be re-performed at 6-12 monthly intervals for recalcitrant lines and wrinkles if the client desires this.
- Currently RegenlabT/PRP renders the most efficient enriched ACR , compared to other products.
SIDE EFFECTS OF PRP FACIAL REJUVENATION
- Minimal: Expect minimal swelling, bruising and redness for 12-24 hours. Some clients experience headache.
- Modest: Some patients may feel faint. A bruise at the venapuncture site may be visible for 2-3 days.
- Severe: A low morbidity procedure. Almost no down time. No need for hospitalization. Anaphylaxis does not occur. In rare cases, skin cellulitis may occur which can be treated with antibiotics and cold compresses. Occasionally hospitalization is needed in these cases. Secondary skin infection is a rare complication.
EXCLUSION CRITERIA FOR PRP/ACR FACIAL REJUVENATION
Persons with skin disease (SLE, porphyria, allergies), cancer, chemotherapy, severe metabolic and systemic disorders, and abnormal platelet function (i.e. blood disorders). Anti-coagulation therapy and underlying sepsis excludes the use of PRP .
EXPECTATIONS FOR AUTOLOGOUS CELL THERAPY
Results are visible at 3 weeks and improve gradually over ensuing months with improvement in texture and tone. Cosmoceuticals can enhance the results. Advanced wrinkling cannot be reversed and a slower improvement is predictable in persons with alcohol and tobacco abuse. Severe scarring may not respond. Subjective response is usually favourable and encouraging. Duration of treatment can still be persistent after 12 months and IPL or non-ablative laser can then be considered. Further plasma treatment is also popular and safe. PRP -mediated ACR is effective and well tolerated, but patient selection is important if predictable results are to be expected.
Costs, inclusive of RegenkitT (authorized for human application and CE marked) are in the range of R5000 - R6000. Discuss this with your practitioner.
REFERENCES AND TESTIMONIALS:PLATELET RICH PLASMA
Chajchir A et al. Growth factors in Plastic Surgery. Aesth. Plast. Surg. 29: 295-299, 2005
Brown GL et al. Enhancement of wound healing by topical treatment with epidermal growth factor. N Engl J Med 321: 76-79, 1989
Eppley BL. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 114: 1502, 2004
Eppley BL. Platelet-rich plasma: A review of biology and applications in plastic surgery. Plast Reconstr Surg 118: 147e, 2006
Bhanot S et al. Current applications of platelet gels in facial plastic surgery. Facial Plast Surg 18, 27-33, 2002
Pietrzak WS et al. Platelet Rich Plasma: Biology and new technology. J Craniofacial Surgery, 16: 1043-1054, 2005
Presentation at Aesthetic Medicine Congress South Africa 5-6 October 2007 Gallagher Estate, Gaugteng ( www.aestheticcongress.co.za
) . Also presented at the plastic surgery congress, Spier (ASSOCIATION OF PLASTIC AND RECONSTRUCTIVE SURGEONS OF SOUTHERN AFRICA: 21-24 October 2007). Professor Donald du Toit
. Aesthetic and biological facial rejuvenation treatment with REGENLAB Plasma (PRP). An alternative to photo-light resurfacing. Abstracts available.
DF du Toit. The Specialist Forum. State of the Art rejuvenation and normal wound healing with platelet-rich plasma growth factors. Part 1 and 2. 2007: 7; 36-42. Reprints available.
Review article on PRP. Shoulder surgeon and autologous cellular regeneration (ACR)-from bench to bed. Part 1-the link between the human fibroblast, connective tissue disorders and shoulder. www.internationalshoulderjournal.org
. 2007. D.F du Toit et al
Soft and hard-tissue augmentation with platelet-rich plasma. Tissue culture dynamics, regeneration and molecular biology perspective. IJSS 2007;1:64-73. www.internationalshoulderjournal.org
. ( D.F du Toit et al
DISTRIBUTORS OF REGENLAB PRP IN SOUTH AFRICA : OMNIMED (PTY), LTD.
Illustration: Short-term 30 day result after REGENLAB PRP/ACR treatment for acne scarring.