REGENLAB ACR 2007
REGENLAB SA MOLLEN: AUTHORIZED PLATELET-RICH-PLASMA (PRP) FOR ACR, HUMAN USE, AESTHETIC AND HOSPITAL PRACTICE
At the International Masters Course On Aging Skin ( IMCAS ASIA JULY 2007, BANGKOK , THAILAND ), Prof Donald du Toit, PHD., FRCS., of Cape Town, the local South African pioneer and scientist on the molecular and cellular biology of PRP, and the clinical application thereof ( i.e. for burns, bone grafting, flap surgery, spinal applications, aesthetic medicine , leg ulcers and wound healing to mention a few indications) gave new insight on REGENACR at IMCAS ASIA JULY 2007 ( ACR: Autologous cellular rejuvenation). See internet connections and links ( www.imcas.com www.acr-prp.com ) for more information. Internationally known for his recent scientific, molecular and cell biology academic and scientific publications in the field of PRP/ACR as well as tissue culture dynamics and PRP, he pointed out important issues regarding the biological dermal regeneration and volumetric therapy via autologous cellular rejuvenation. The keynote lecture at IMCAS ASIA 2007, on the application of PRP for aesthetic application was attended by Prof Benjamin Ascher, specialist plastic surgeon, and IMCAS Asia 2007 Course Director. Dr Junichiro Kubota , a plastic surgeon from Japan and working independently, gave a similar and balanced overview on the facial skin rejuvenation properties of REGEN-PRP-mediated ACR.
REGENLAB (REGEN-ACR): SCIENCE BEHIND PLATELET-RICH-PLASMA (PRP) FOR AESTHETIC PURPOSES
Classic wound healing and regeneration pass through the phases of haemostasis, inflammation, tissue regeneration and tissue remodelling (maturation). Recent anecdotal reports indicate that it is possible to move the curve to the left by intradermal and hypodermal injections ( for facial aesthetic purposes), containing activated autologous platelets that release growth factors such as PDGF, VEGF, IGF, TGBF, and IGF. In theory, this would mean the point of exit would be enhanced tissue regeneration and tissue remodelling. This hypothesis would then be based on established principles of wound healing as scientists understand it to-day.
From a cell biology perspective, this innovative approach of administering a combination of target specific GF, intra-and hypodermally, addresses such issues as epithelial growth, regeneration of the ECM, epithelization and angiogenesis ( see Du Toit et al: Soft and hard tissue augmentation by PRP. International Journal of Shoulder Surgery; vol1, April 2007 ). The regenerative model as mentioned before, is summarised as follows:
- Formation of 3D fibrin mesh and platelet cohesion ( via calcium and thrombin)
- Platelet and leukocyte release of growth factors: At the time of writing 7 secretory proteins are released ( PDGF, TGBF,IGF,EGF,FN,VEGF, Osteopontin). In REGEN-PRP, scientific data is available on PDGF,EGF,TGBF and VEGF).
- Local stem cell proliferation
- Local tissue stem cell differentiation ( and therefore enhanced tissue regeneration and tissue remodelling)
REGENLAB SA: AVAILABILITY OF KITS AND BLOOD COLLECTION DEVICES FOR PRP SEPARATION-HARVESTING AND PREPARATION.
REGENLAB , Mollens, provide sterile and sealed, CE market kits, authorised for medical use, blood harvesting and PRP administration by injection (SWISS BIOTECH, ISO 9001-2000; 13485-2003; 14644-GLP; CTI CERTIFIED, SWISS MEDIC: see info @ regenlab.com, www.regenlab.com www.acr-prp.com ). The manufacturer for REGEN ACR is as follows: CH 1146 Mollens-VD , Switzerland : Tel: + 41218643800: Fax+ 41218643801. Instructions of the manufacturer must be followed. Avoid using loose, unpacked blood harvest tubes, needles and other tubes. [platelet clumping may occur and cross infection to the enriched platelet plasma may occur if protocol of antisepsis is breached. Five different Regen Kits are available, each for a specific indication i.e. dermatology, mesotherapy, aesthetics, plastic surgery, cardiovascular surgery.
REGENKIT: ATS AND ACR, PRP PROTOCOLS
- Patient selection: Patient meets inclusion criteria and contraindications identified ( i.e. platelet disorders, blood clotting disorders, lupus, infections, serious systemic disorders, neoplasia, vitamin-E, anti-inflammatories, steroids)
- Kit selection: select for the right indication ( aesthetic or therapeutic)
- Venapuncture and blood harvest into designated tubes, at the same time avoiding platelet activation, cross contamination with infections. Label tubes correctly with patient's initials and surname. Process and centrifuge harvested blood immediately or get it transferred post haste to a registered laboratory with specialist services.
- Centrifugation: Consider two, split centrifugation technique. Centrifugation separate blood into RBC, " buffy coat"(white blood cells and platelets) and plasma ( PRP and PPP ).
- For aesthetics, draw off PRP and activate with calcium chloride (a vial is supplied in the kit). Platelets are thus activated and a gel will form.
- For facial rejuvenation and aesthetic treatment, prior knowledge of local anaesthesia and anatomy is essential as well as previous hands on training gleaned from an expert in the field. Make sure adequate anaesthesia is given. EMLAT cream is useful and complimentary.
- Injection: Deliver (like mesotherapy) PRP to dermis and hypodermis. Use 30 gauge needle supplied in the kit, because it has extra length. Avoid orbit regions, thereby reducing emboli into orbital and cranial venous sinuses. Ice packs can be considered. Avoid haematomas ( side of eye, and glabella region).
- Anti-sepsis: Clean skin with anti-septic Webcol or Preptic swab, wear gloves and mask.
- Anatomical injection sites on the face: Forehead, glabella, crow feet, malar, buccal, upper lip, nasolabial folds, chin, neck, back of hands.
- Approximate volumes of PRP needed for facial rejuvenation:
- Total face: 16 ml ( need 4 blood harvest tubes to render 32 ml)
- Hemi-facial: 8 ml ( need two 8ml harvest tubes)
- Dorsum of hand: 4-8 ml per hand
- Approximate cost of REGENKIT : 150 Euro ( excludes practitioners fees and clinic cost)
- When can facial improvement be expected: Texture changes are visible at 2-3 weeks, but obviously one cannot reverse 40 years of skin aging overnight. With most regeneration technologies the reversal and amelioration is gradual over months. And then ongoing maintenance treatment is needed to combat ongoing aging.
- Duration of result: Depends on the Fitzpatrick and Glacou scale and presence and absence of solar-aged features, depth of wrinkles, degree of sagging, thinning of the skin and presence of mid face ptosis and jowls.
- Advantages of REGEN/ACR : Preparation provides for enhanced biological wound healing by growth factors derived in the PRP and a sealant effect for reducing oozing, fluid collections and haematomas as well as bruising.
- Aesthetic medicine: Aims: T ameliorate and augment the aging skin, improve complexion and texture of the skin, reduce sagging, reverse/improve lines, wrinkles, bags and sagging neck.
- Safety: Autologous plasma (from the same person is used), is safe to use and side effects negligible. Safety and efficacy have been shown in England and Japan and data has been presented for peer-review at IMCAS 2007 IN Bangkok, Thailand. Live demonstration on REGENLAB SA ACR/PRP injection was given at IMCAS 2007, by Prof Donald Du Toit, a highly experienced vascular clinician and expert in molecular cell biology, including tissue culture. Five points were demonstrated and potential pitfalls.
- Need for adjunctive therapy. Yes. Avoid the sun and apply sun block 30-100 and wear a broad brimmed hat. Advise day and night creams, plus moisturisers. Vitamin-A based creams are good but skin sensitization in the sun, with redness, sensitivity and flaking are known. Gentle facials at salon/Spa/ Medispa are recommended with microdermabrasion. IPL and lasers are usually not indicated but RF may have a place. Some patients may require a second set of injections to beautify missed areas or areas that regenerate at different and variable paces. Those schooled in the art of skin histology of the various areas of the face will understand this problem. In select cases Botox or Restylane have proved effective but include hidden cost for the client. Follow-up PRP injections are inevitable in some clients after 6 months, and persons must be aware of this eventuality because there is no one absolute cure for the aging skin or a magic bullet. Creams such as ENVIRONT , NEOSTRATAT ( facial bionic serum) or PREVAGET can be considered, apart from the clients own personal choice.
- Advantages of REGENLAB ACR/PRP : Safety and efficacy. Authorised, CE marked kits for human use (harvest and preparation of PRP ). This allows for protection of practitioner, health care-provider, assistants, and patient. Minimal side-effects, painless procedure if performed correctly under local anaesthesia. PRP has been subjected to rigid biological cell culture technology in Switzerland and Cape Town . Safety as regards cell biology ex-vivo, without the use of animal testing, has been confirmed and published in peer-review journals. Special training course on PRP preparation and injection technique are given by an academic in Cape Town and other centre to address the academic needs of the scientific and health community and to ensure safe standards, and protection of the public. From a PRP cell biology perspective in Cape Town :
- Enhanced proliferation of fibroblasts, stem cells and myofibroblast
- Enhanced restoration of the extracellular matrix( ECM)
- Enhanced proliferation and differentiation of keratinocytes that are essential for a smooth complexion. Enhanced release of collagen from activated fibroblasts, thus restoring the ECM and enhancing thickening of the dermis.
SUMMARY: REGEN ACR is a biostimulatory injection technique that utilizes the patients own bioactive platelet-rich-plasma ( REGENPRP ) with the aim to regenerate aged and damaged skin and hypodermal tissues.
CHALLENGES FACED BY ALL SPA'S, MEDIISPA'S, CLINICS, AESTHETIC PRACTITIONERS WHEN REJUVENATING THE FACE, NECK, AND HANDS BY NON-INVASIVE OR MINIMALLY INVASIVE TECHNOLOGY WITH BIOLOGICALS
- Rejuvenation is a gradual process and takes months.
- Formation of new ECM, collagen and fibroblast takes months and is a very gradual process. So, keep notes to gauge process.
- Most often results of treatment are highly variable and inconsistent (includes such treatments as RF, IPL and fractional photo light therapy).
- Post inflammatory hyperpigmentation ( PIH) is a major problem and headache as well as hypopigmentation, for those engaged in the use of IPL and lasers. Many sessions of treatment ere needed and maintenance therapy is strongly advised to deal with the ravages of the ongoing aging process that accelerates between the ages of 50 and 90 years, and fuelled by alcohol and tobacco. One has to rely on creams in the interim to hide the formation of lines and wrinkles.
- A properly performed and staged face-lift gives far superior results than non-invasive therapies; deals better with the sagging face, dew laps, harsh wrinkles, double chins and eye bags without the damage of laser scarification. A correctly performed blepharoplasty for eye bags renders far better results over decades, than non-invasive attempts at antiaging. Once the bruising and swelling of surgery are gone, the new results are seen quickly, and all that needs dealing with is a short down time that is over-exaggerated by aesthetic physicians not skilled in the art of facial-surgery-sculpturing. Surgery is really a quick fix not achievable with non invasive technology. Selection of your surgeon is important so as to ensure that you do not end up with a static 2D face. Don't forget, once the surgery is done it is one off. No more coming back and back for more non invasive face treatments with variable results. If one adds up all the costs of follow up treatments with machines it is more than a surgical face lift, and that means many visits to the therapists. With surgery, you don't have to come back, until you want to. Your result is visible in tree to four weeks. And now there is good news for the plastic surgeons. On completion of the miniface lift, Intradermal injections of REGEN PRP can be given in theatre on completion of the procedure that will ensure further rejuvenation properties. For the interested public this means surgical correction of the ugly sagging face and jowls and the same time injecting the PRP with skin rejuvenating properties to enhance the surgical results. BOLANDCELL recommends this approach as it makes sense by mechanical excision of sagging skin, ironing out terrible wrinkles and at the same time rejuvenating yourself with your own growth factors derived from platelets in your enriched plasma. Results of a well performed face lift with avoidance of over-correction can be long lasting from for 10-15 years, results not achievable by lasers, IPL or RF. They just simply cannot compete with the surgical knife or scalpel in the hands of the expert. Now combined with REGEN ACR/PRP , more than excellent surgical results can be anticipated. Early reports already shoe the synergistic affect of surgery and plasma growth factors.
- Home -based RADIANCY and E-Laser together with SPA microdermabrasion give excellent results if not better than non-ablative IPL, lasers and RF.
- How does one deal with mid face ptosis, pigmentation over the malar regions?
- Can telangiectasis over the bridge of the nose be abrogated by IPL?
- Diffuse telangiectasis and lipoatrophy remain major obstacles.
- How can we get a 3D face and move away from a 2D face? ( pulled and sagging face).
- What is the best for upper lip wrinkles, nasolabial folds and puffiness around the eyes? REGEN-PRP , machines, RF and IPL. And non-ablative fractional photothermolysis? Or nitrogen plasma regeneration? Biologicals versus lasers, IPL and RF?
- Is ACR enough or is autologous fat transfer needed for ugly hollows? Again, patient selection is important.
- What is the best option for jowls, mid face sagging and ptosis as well as eye bags? Is it to be blepharoplasty or unproven lasers/IPL?
- Don't forget peels in the hands of experts and that includes microdermabrasion plus creams that give excellent results with no down time and little cost.
- What about the puffy face with nasal bridge and ala telangiectasis?
- Is RF enough for the ugly sagging neck with deep horizontal creases due to solar aging?
- What is the best for fine and deep crow feet? Is it not microdermabrasion on a regular basis plus good quality creams with an odd few peels thrown in?
- Can RF restore a youthful face, with soft full appearance?
- Remember even natural fillers work out in a period of 6-9 months.
- For complete reversal or augmentation of the aging face we need to address hard and soft tissue regeneration, the former being impossible to reverse at the moment.
OUR BIGGEST CHALLENGES AT THE MOMENT FOR PATIENT AND THERAPIST
- Premature aging of the face due to genetic make up
- Solar aging
- Damaged face due to alcohol and tobacco abuse
- Atrophy of hard and soft tissue of the face
- Loss of 3D facial structure and contours
- Sagging deep lines, due to loss of anti-gravity support of the overlying skin
- Blotches ( lentigens), pigmentation, telangiectasis and melasma
- Sagging redundant skin
- Sagging neck
- Mid face ptosis
- Finally: how do we deal with the upper face, mid face and lower face? (Will this not be the place foe biological rejuvenation by PRP/ACR in one sitting?