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PLATELET RICH PLASMA

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PLATELET RICH PLASMA

PRP in Aesthetic Medicine and its Possible Role in Rejuvenation with Own Regenerative Stem Cells


This article discusses PLATELET RICH PLASMA’S (PRP) aesthetic application and describes its effect in a small controlled study. The patients’ own platelets and blood serum is re-injected into the skin to promote healing by growth factors and secretory proteins. Since the 1970s, PRP has been studied and is known to be effectively supercharge the body’s capacity to rejuvenation, wound healing and tissue repair. The PRP treatment is described in numerous articles for tendon, bone and skin healing and has been used successfully and safely for many years.

The aesthetic application started Europe and South America Less than 10 years ago, the procedure is known as mesolift. The author recently reviewed articles which summarize new possibilities and ideas on how to make visible and unfold the mystery of stem cell behavior by injecting the skin with autologous plasma.

Applications of PRP

The study raises the intriguing idea of epidermis-harbored stem cells’ role in the skin self-regeneration at the local epidermis level where the stem cells are and “sleep” in absence of stimuli. Aging is defined as “chronic wound” that affects a large area of skin. Over time the healing process of the body or its ability to regenerate is slowed down and eventually lost. The aging of the skin produces up to 20% collagen reduction, among others. Most of the non-surgical procedures applied in aesthetic medicine are geared to replace this loss of collagen by fibroblast stimulation at the dermis level.

With the newly introduced fat stem cell transplant and the PRP, the three main components of skin – epidermis, dermis and subcutaneous fat – are addressed, further expanding the anti-aging, non-surgical treatment modalities applied by aesthetic medicine.

The tissue-healing action of PRP is emphasizing the importance of growth factors like platelet-derived growth factors (PDGF), fibroblast growth factor (FGF) released by the activated platelets once injected back to the injury site in the cited studies. The re-injected platelet and serum can be regarded as a culture medium to induce differentiation, to induce “in vivo culture of keratinocytes” and the “sleeping stem cells awakening” in the epidermis basement membrane and hair follicles to participate in the healing and regeneration of the skin.

The stimulated differentiation of epidermis, dermis cell components and the stem cell activation in the presence of plant-based cultures stem cell products (DermaSwiss Nanosphere+ Plus, Nelly De Vuyst Lifecell) are also addressing the cosmetic industry participation in this new trend.

Basic Science Background

Upon fertilization, the totipotent cells differentiate leading to pluripotent cells which further differentiate into somatic cells to produce specific tissues and body organs. Only few tissues were regarded to keep its capacity of renewal after birth like blood, teeth, reproductive organ, the eyes and skin. Details of new cell differentiation, induced pluripotent stem cell nuclear reprogramming of adult somatic cells into stem cells waited its discovery until recently – the medical concept of how to induce pluripotent cells, stem cells to differentiate and reverse differentiation, how to make in vivo and in vitro culture with stem cells today is a reality.

The breakthrough results of the stem cell investigation of Martin Evans in 1981 opened up a brand new field of medicine – Regenerative Medicine. Sir Martin Evans received a Novel Prize in 2007, and the 21st century medicine thinking changed. The Aesthetic Medicine field, along with Plastic surgery and Dermatology, is gaining its growing speed toward a multimillion dollar industry, applying non-surgical beautification techniques capitalizing from the basic science results.

In 1998, the Jamie Thomson research described the totipotent cells in embryo; how some differentiate fully to produce bone-muscle-ligament, some multi-potent cell stay in their environment to start “working’ later, like adult stem cells. As we age, these cells are “sleeping” and probably take strong cell communication signal to “wake them up”.

In the skin, these pluripotent cells are located in the epidermis basement membrane and the stem ridge of the hair follicle. Valery Horsey et al described the follicle intrusion to the dermis, where the numerous non-epithelial cells regulate epithelial cell behavior. Jamie Thomson described in 1998 her in vitro observation “the human embryo stem cells (hES-cells) pile up” and then they “tell each other” to stay undifferentiated. Then after a chemical number they send each other chemical messages “it’s time to move and differentiate to stop nurturing each other and start working together”. She also found the adult blood cells to guide human embryo stem cells (hES) when co-cultured – an approach that took advantage of the communication nature cells.

Most of the aesthetic modalities produce minor wound in the layers to induce self-regeneration, the PRP aesthetic application raise the possibility of “in vivo culturing the epithelial layer keratinocytes”, leading to double benefit. Inflammation and repair induced fibroblast by growth factors and multiplication of the keratinocytes to “bloom the flower”; the keratinocytes differentiation is visible since the epidermis regeneration starts at the basement membrane/hair follicle level. Now, details of behavior and the role of the local stem cells in this process is still subject for more research.

The author conducted a small number controlled study of PRP treatments. In the study, well established Harvest Technology Smart PReP2 was used. It is a low-cost simplified autologous plasma preparation process – venipuncture requiring 60cc of blood. Separation of plasma and platelets from red blood cells was done by centrifugation, taking only 14 minutes and delivering 8ml of plasma from the original 55ml whole blood. Anti-coagulant is used in the blood drawing syringe and before re-injecting the separated plasma platelet activation occurs by adding Activators.

How PRP Works?

Using micro gauge needles, the participants’ own platelets are injected into areas of chronic cellular injury, also known as wrinkles, scars, darks spots, pigmentations, and fine lines. Mesotherapy injections with platelet-poor plasma enhance the value of treatment. In theory, the injected autologous platelet-rich plasma induces the formation of a tri-dimensional fibrin strand including platelets. The alpha-granules of platelets release growth factors like PDGF and EGF to induce chemo-attraction of macrophages and stem cells to the site, and induce stem cell proliferation (mitosis) and stem cell differentiation in vicinity of bio-active ‘scaffold’, and other cell communication take place.

PRP is given in one-month increments. Before starting the PRP treatment, pictures are taken. Then at one week post-procedure, a follow-up photo is analyzed to show improvement.

Materials and Method

The study design and protocol were presented by the author to the participants and research committee. All patients signed a detailed informed consent form prepared according to the guidelines for preparation protocols for Human Investigation Committee.

In total, six women (N=6) participated in the study, and the day of injection were at day 1 and day 30. Seven PRP treatment results were used for comparison, where the platelet-rich plasma separation techniques were different. Peripheral blood (8ml) was collected in Regen-tubes containing anticoagulant and centrifuged at 3000rpm for five minutes, and the top pellet was re-injected after activation of platelets.

In this pilot study, the results were captured with before and after photos only. Each subject was selected based on the age and presence of fine and deep wrinkles. Four subjects were in the age group 50 to 60, one in 20 to 30, and one in 40 to 50.

Before the treatment, each subject face analyzed with Canfield Imaging Systems Visia camera and recorded. The one-week after-treatment Visia Complexion analysis Report was generated. The PRP treatment is a one-hour office procedure. Each subject’s face was washed with cleanser and toner, and treated with topical anesthesia.

A 21G needle was used for venipuncture and 60cc antecubital blood was collected with Anti-coagulant and centrifuged accordingly to Harvest SmartPReP system protocol. Sample blood for platelet count before and after separation was taken and Medonic M- series analyzer was used to detect blood cell count. Four-to five-fold increase of platelets were identified in the blood samples after separation. For example, the Platelet counts 288 x 1000/uL before the whole blood and 110 x 1000/uL after spinning platelet-rich plasma.

The activated platelet-rich serum was injected in the dermis and then the entire face and neck were injected using 31G needles with platelet-poor plasma into the superficial dermis-epidermis junction. The second PRP treatment seemed to enhance its effect by applying cosmetic product containing stem cell culture (DermaSwiss Nanosphere-Plus) in one side of the face for one week.

Conclusion

The study setting presented was well accepted by the participants and was enhanced by introducing a tool measure and analyze complexion changes other than the camera before and after pictures and the subjective satisfaction. Also, the confirmed platelet number increase after Smart PReP centrifuge by utilizing Medonic analyzer increased the confidence of the participants toward PRP. At the same time, they benefited from the blood count results. The plant stem cell products used showed benefit and seemed to “feel better”.

PRP and fat cell transplant are both autologous injection techniques with no adverse effects and relatively low cost. The stem cells of our own body is stimulated or transplanted to the skin. The 21st century research results from laboratory to application took a remarkable short time. It is worth to mention that the cosmetic industry is not staying behind; the Swiss apple cultured stem cells are providing stimulus and “positive memory” hoping to make our stem cells work. The new list of different plants are providing stem cells cultures as part of the ingredients to its product to mimic the ideal condition of the skin renewal, to “wake up the sleeping skin epithelial stem cells” to slow and reverse the aging.

The desire of the aesthetic medical professional is to find ways to document changes in what goes beyond the detection with a camera and a subjective feeling of the treated patients. Example is using microultrasound to detect the thickness changes of the skin while treated and beyond. Now it is cost prohibited, but in the future we can count on detecting the preventative signs of the “stem cells going to sleep”, before it takes longer and more costly to treat the aging process.

References

Crane, D. & Peter, A. (2008). Platelet Rich Plasma (PRP) Matrix Grafts. Practical Pain Management, January/February 2008.

Foster, T.E. & Puskas, B.L. & Mandelbaum, B.R. & Gerhardt, M.B. & Rodeo, S.A. (2009). Platelet-Rich Plasma from basic science to clinical applications. The American Journal of Sports Medicine, 37 (11).

Kochan, A. & Sccarpone, M. & Mandle, R. (2009). Platelet Rich Plasma Preparation: A Comparison of the Harvest SmartPRep 2APC+ with the Ateriocyte Magellan.

Mishra, A. & Pavelko, T. (2006). Treatment of Chronic Elbow Tendonitis with Buffered Platelet-Rich Plasma. The American journal of Sports Medicine. DOI: 10.1177 Monteleone, K. & Marx, R. & Ghurani, R. (2000). Wound Repair/Cosmetic Surgery Healing enhancement of skin graft donor sites with platelet-rich plasma. University of Miami School of Medicine.

Schultheiss, H. (2008). Non-surgical repair of patella tendonitis with autologous platelet concrete using ultrasound guidance: two case reports.

Scarpone, M.A> (200). Non-surgical repair of high grade Achilles tendon tear by autologous platelet graft platelet-case

1. Chronic medical collateral high-grade tear: treatment with autologous platelet concrete injection with ultrasound guidance-case

2. Stiene, H. (2008). Non-surgical repair of patella tendonitis with autologous platelet concrete using ultrasound guidance: two case reports.

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