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- 1. How to enhance the results of aesthetic procedures using Platelet-Rich-Plasma Dr. Rolf Soehnchen Consultant Dermatologist Cooper dermatology Clinic Dubai, UAE dermadoktor@gmail.com
- 2. • Vampire lift • Dracula lift • Plasma lifting
- 3. “The natural healing force within each of us is the greatest force in getting well.” Hippocrates 460-370 b.c.
- 4. Blood components: 93% RBC 6% platelets 1% WBC PRP: 95 % platelets & plasma 5 % RBC
- 5. thrombocytes are irregular, roughly spheroidal 2 μm, anuclear Lifespan 5-9 d achieve hemostasis 150,000 - 450,000 /μl /ml if activated (for e.g. injury, thrombin, CaCl2) secret growth factors from alpha granules platelets mediate: •cell differentiation •Promote angiogenesis •Cell migration •cell-to-cell adhesion molecules •release of growth factors, cytokines Platelets
- 6. A natural Injectable -
- 7. What is Platelet-rich plasma? • Plasma with platelet concentration above base line values are referred to as platelet-rich plasma (PRP). • PRP is a sample of a patient’s own blood and spinning in a centrifuge for certain minutes. • As a concentrated source of autologous platelets, PRP contains, and releases (after activation) several different growth factors and other cytokines that stimulate regenerating & healing soft tissues. Ashish Jain et al. Platelet-rich plasma therapy: A novel application in regenerative medicine Asian J Transfus. Sci. 2015 Jul-Dec; 9(2): 113–114.
- 11. VEGF FGF IGF TGF -b PDGF EGF PRP Activated Platelets
- 12. Biological Rationale - Insulin like Growth Factor (IGF 1 & 2) Regulates cell growth Platelet Derived Growth Factor (PDGF) Cell growth, new generation and repair of blood vessels, collagen production Fibroblast Growth Factor (FGF) Tissue repair, collagen production Epidermal Growth Factor (EGF) Promotion of epithelial cell growth, angiogenesis, promotion of wound healing Vascular Endothelial Growth Factor (VEGF) Growth and new generation of vascular endothelial cells Transforming Growth Factor – β (TGF- β) Growth of epithelial cells, endothelial cells, promotion of wound healing PRP Stem Cells Growth Factors Angiogenesis Collagen/Elastin Biosynthesis
- 13. PRP Growth Factors & Matrix proteins Growth factors 1. Vascular Endothelial GF (VEGF) 2. Fibroblast GF (FGF) 3. Insulin like GF (IGF) 4. Transforming GF β1 (TGFβ1) 5. Platelet-Derived GF (PDGF) 6. Epidermal GF (EGF) Extra Cellular Matrix facillitates cell adhaesion 1. Fibronectin 2. Vitronectin 3. Thrombospondin-1 4. Collagen
- 14. PRP in wound healing cascade Haemostasis Inflamation Regeneration Remodeling Haemostasis Inflammation Regeneration Remodeling time with PRP wound healing time can be shortened significantly Leucocytes Chemotraction & Mitotic G factors extracellular matrix & cell differentiaton Fibrin & Platelet aggregation w/o PRP
- 15. Skin rejuvenation by PRP proposed mechanisms of action Mechanisms of action for PRP in skin rejuvenation • Increased fibroblast proliferation > increased collagen production • Upregulates expression of MMP-1 , and MMP -3. > removal of photodamage • Increased G1 cell cycle regulators > accelerates wound healing Platelet-rich plasma induces increased expression of G1 cell cycle regulators, type I collagen, and matrix metalloproteinase-1 in human skin fibroblasts. Chow JW, etal. , Int J Mol Med 2012;29:32-
- 16. Why –
- 17. Why – Dr. Sabine Zenker, Novel insights on the platelet-rich fibrin matrix, Prime, International Journal od Aesthetic & Anti-Ageing Medicine Injectable Treatments on November 15, 2013.
- 18. PRP stimulates Fibroblasts aPRP= activated PRP aPPP and aPRP treatment increased the proliferation of cultured fibroblast. - serum-starvation for 24 h, fibroblasts were cultured with FBS, aPPP, or aPRP at 5% and 10%. For 3 days. Can Platelet-rich Plasma Be Used for Skin Rejuvenation? Evaluation of Effects of Platelet-rich Plasma on Human Dermal Fibroblasts, Ann Dermatol. 2011 424-431, Kim Dh, et al.
- 19. PRP increases proliferation of epidermis basal cells and hair follicular bulge cells before PRP before before after after after Ki 67 Ki 67 CD 31 Source: The Effect of Autologous Activated Platelet Rich Plasma Injection on Pattern Hair Loss: Clinical and Histomorphometric Evaluation, Cervelli et al. , BioMed Research Intern. Volume 2014 (2014), Article ID 760709
- 20. Contra • Secretion of proinflammatory cytokines , such as MMP, serin proteases, oxygen radicals • Neutrophils trigger increased tissue matrix degradation • Pro inflammatory WBC fraction might inhibit healing process • Increase localised pain It seems desirable to have a low amount of WBC & red blood cells PRP and White Blood Cells Pro • WBC fraction contains stem cells which are essential for woundhealing • Antibacterial effect
- 21. The inclusion of WBC’s in PRP may not have any scientific basis, but rather reflect an inability of the preparation technique to completely eliminate this cellular component. Dohan-Ehrenfest 2009, Mei-Dan 2010
- 22. PRP selection • Blood volume required • Blood Collection tube (With Gel Separator / Without Gel Separator) • Centrifugation time & speed • No contamination of RBCs & WBCs. • pH of PRP • Activation agent of PRP
- 23. PRP Selection • PRP brand • PRP at 2800 rpm centrifugation for 6 minutes. No RBCS & WBCs contamination Advanced Gel Separator • Reduce the risk of free radicals generation, inflammation, tissues injury & cell death. High RBCs concentration = Hemosiderin staining. Removes 99.8% RBCs • Reduce the risk of tissue damage, inflammation, impaired healing & local pain. Removes 90% WBCs
- 24. PRP Selection • PRP brand • No burning pain during & after PRP injection as it is in the range of blood pH. Maintains 7.4 pH of PRP • Eliminates the risk of contamination Closed System • sustained release of growth factors & bioactive matrix proteins Separate PRP Activation Tube with CaCl2
- 25. Simple Preparation Steps Transfer to Syringe (Ready for application) Transfer (transferring PRP into activation tube) Centrifugation (6 minutes, with 1100g or 2800 RPM) Blood Draw (with vacuum system to prevent contamination)
- 26. 2800 rpm 6 mins. transfer in into activator tube CaCl2
- 27. PRP Applications • PRP Aesthetic Application: Also for: Acne scars Hair restoration in combination with fat cell filing (Loose saggy skin)
- 28. Upper eyelid: Subdermal, punctate 0,2 ml/ inj. < 0,6 ml Lower eyelid: Subdermal, 0,2 ml Massage evenly < 1-2 ml Midface/ Cheeks: linear threading 0,2 ml/ inj. Max. 3-5 ml Nasolabial/upper lip: linear threading 0,2 ml /inj. site, < 2-3 ml Chin: linear threading max. 2 ml Forehead: intradermal punctate 0,05/inj.
- 29. Injection techniques • Linear threading • Micro wheals, Nappage (depth of 0.5-2.5 mm) • Fanning • Crosshatching
- 30. 2 PRP treatments ; linear threading technique
- 31. before after 2 months
- 34. PRP enhances the result of micro needling Micro Needling Wound Healing Process (Skin Renewal) Transdermal Routes (Increased Absorption)
- 35. Before after 3 months 2 PRP treatments PRP & Dermapen
- 36. Assessment of efficacy of platelet-rich plasma (PRP) on infraorbital dark circles and crow’s feet wrinkles, Pedram Mehryan, MD, et al. , Journal od Cosmetic Dermatology 13, 72-78 PRP & dark Circles
- 39. PRP & Fractional Erbium Yag Laser Before After three Sessions
- 40. After 3 PRP treatments
- 41. PRP combination therapies PRP & RF Efficacy of intradermal radiofrequency combined with autologous platelet-rich plasma in striae distensae: a pilot study, Int . J Dermatol 2012 Oct;51(10):1253-8, Su Kim et al PRP & Microneedle / RF Skin rejuvenation by microneedle fractional radiofrequency and a human stem cell conditioned medium in Asian skin: a randomized controlled investigator blinded split-face study . Cosmet Laser Ther , 2013 Feb;15(1):25-33. , Seo KY, et al. Efficacy of Microneedling Plus Human Stem Cell Conditioned Medium for Skin Rejuvenation: A Randomized, Controlled, Blinded Split-Face Study Ann Dermatol. 2014 Oct; 26(5): 584–591. Lee Hj et al. PRP & Ultrasound Treatment of Striae Distensae Combined Enhanced Penetration Platelet-Rich Plasma and Ultrasound after Plasma Fractional Radiofrequency. Dong Hye Suh, J Cosmet Laser Ther 2012 Dec;14(6):272-6 PRP & Fx Laser • Platelet-rich plasma combined with fractional laser therapy for skin rejuvenation Dermatol Surg; 2012 Apr;38(4):623-30. Shin MK, et al. • Rapid healing and reduced erythema after ablative fractional carbon dioxide laser resurfacing combined with the application of autologous platelet-rich plasma. Dermatol Surg 2011 Apr;37(4):463-8. , Na Ji, Choi JW, et al.
- 43. PRP & Hair Growth A nonsmoker 52-year-old male patient affected by hair loss. (a): Preoperative situation of the scalp with hair loss localized to the parietal and vertex areas. (b): Postoperative situation of the scalp two weeks from the last treatment with increase of the hair count and hair density. Source: Cervelli et al. The Effect of Autologous Activated Platelet Rich Plasma (AA-PRP) Injection on Pattern Hair Loss: Clinical and Histomorphometric Evaluation, BioMed Research International Volume 2014, Article ID 760709, 9 pages
- 44. Thank you for your interest
Notes de l'éditeur
- Platelet-rich plasma, or PRP, is blood plasma with concentrated platelets and other growth factors. The concentrated platelets found in PRP have huge reservoirs of bioactive proteins, including growth factors and signalling proteins. Dr Georghy utilizes platelets rich plasma (PRP) and various growth factors and supplements to improve everything from aging skin, stretch marks, hair loss, tennis elbow to degenerative arthritis and much more. A new cutting edge technology in regenerative medicine utilizes the patient’s own platelets rich plasma (PRP) which can repair and rejuvenate without drugs or medications. Our practice is a leader in introducing integrative medical and surgical techniques which are safe and effective. PRP is a naturally occurring component extracted from your own (autologous) blood. Blood is made up of red blood cells, white blood cells, platelets and plasma. When platelets are activated in the body they release healing proteins called growth factors. Growth factors create a cumulative result, which assists the body to repair itself by regenerating new tissue, improving blood supply and wound healing, all of which are important factors in regenerative therapies.
- Dr.Sabine’s investigations into the impact of PRP on dermal augmentation found that dermal intensities increased following treatment. She used meso- and filling methodologies for full facial rejuvenation to objectively evaluate the effects of three PRP treatments spaced 1 month apart, then analysed the effects of superficial dermal stimulation and augmentation using 20 MHz ultrasound measurements. Treatments were administered to the nasolabial folds, tear trough, and cheeks, with significant preliminary results in skin thickness and neo-collagenesis after only one treatment
- There are great differences among the commercially-available PRP preparations that the aesthetic practitioner should be aware of, including: -The volume of autologous blood required, which can vary depending on the kit used -The time and speed of centrifugation -The nature of plasmapharesis, including the removal, treatment, and return of (components of) blood plasma from blood circulation -The addition of an activating agent and its effect on pH -The final platelet, growth factor, and leukocyte concentration The growth factors amount is still worthy of further investigation and that a technique whereby the growth factor content could be rapidly assessed in PRP may be of therapeutic benefit. The platelet, and consequently the growth factor, availability also depends on the use of the harvesting kit. Similar methods for platelet gel preparation revealed different performances concerning growth factor recovery and the kinetics of its release from the gel. It is unclear whether these noticeable differences are important for clinical management. Further features of PRP is amount of blood that is needed. In fact, it is often considered that the lowest draw of blood is actually more beneficial for treatment, as well as a shorter time of centrifugation, which maintains the platelet’s integrity and practicality. The physiological pH means that when the PRP is injected, cellular integrity is further maintained, and the patient will experience only a minimal sensation of pain. It is also important to be wary of potential contamination and the resulting purity of the final PRP product. The purity of the final PRP product matters. When high numbers of red blood cells are present in the final PRP formulation, the erythrocytes present will induce the oxidization of extracellular hemoglobin, thus releasing heme (the deep red, non-protein, ferrous component of haemoglobin, C34H32FeN4O4) and reactive ferric oxide. Free radicals are generated, which lead to inflammation, vascular injury, and cell death; additionally, free heme can lead to haemosiderin staining from iron oxide. Some authors do not highlight the controversial issue of whether high or low concentrations of white blood cells in the final PRP are desirable or not. If high numbers of white blood cells are present in PRP, leukocytes will also be present, which release matrix metallo-proteinases (MMPs) and produce oxygen radicals/cytokines (catabolic or inflammatory). Thrombin also significantly increases leukocyte IL-1β production18, which can lead to tissue damage, inflammation, and impaired healing as well as localized pain. As a result, it is desirable to have low volumes of white and red blood cells in the final PRP product, as well as low and consistent rates of platelets, to ensure PRP quality. Liquid PRP can be used to inject into the dermis but for wound healing, PRP gel or a fine delicate membrane is also very important to put on the wound to accelerate healing.
- PRP stimulates the follicular cells of the transplanted or non-transplanted hair in the affected region. PDGF (Platelet Derived Growth Factor): PDGF signals are involved in both epidermis-follicle interaction & the dermal mesenchymal interaction required for hair canal formation and the growth of dermal mesenchyme. VEGF (Vescular Endothelial Growth Factor): VEGF is a major mediator of hair follicle growth and cycling. VEDGF improves follicles revascularization that promotes hair growth and increases follicle and hair size. Epidermal Growth Factor (EGF), Fibroblast Growth Factor (FGF) & Transforming Growth Factor-Beta (TGF-beta) provides necessary input in terms of fibrin & elastin protein which are required for hair growth.