IntrotoPRP,RichardWeissMD 1

IntroductiontoPRP(PlateletRichPlasma)RichardWeiss,MDMarch14,2017

PRPisbeingwidelyusedbyitselfandincombinationwithlaserskinrejuvenationto

reducefacialwrinklesandimprovethetoneandtextureoftheskin.Withinthelastsix

months,Ihaveincorporatedthistechniqueintomypractice.Havingseenmany‘fads’

comeandgointhisfield,Iamcautiousabouttheevaluationofnewmethods.Inthe

caseofPRP,becausetheresultsarefrequentlylessthan100%(inotherwords,we

reallycan’tmake60year-oldskinlooklikea20year-old–atleast,notineveryone!)it

isespeciallyimportanttohaveahealthyskepticismaboutexcessiveclaims.

InthecaseofthePRPtechnique,Ithoughtitmightbeinterestingformetoexplain

exactlywhatPRPdoes,andtoquotesomeofthescientificevidenceinpeer-reviewed

publicationsthathasconvincedmethatPRPisanimportantnewadditionto

rejuvenationprocedures.IoftenmentiontomypatientsthatIamalsoascientistwith2

patentedinventionsandmanypublishedpapers.Withthatinmind,I’dliketo

summarizesomeofthedatathatsupportsmyclinicalimpression(basedonmy

patient’simprovements)thatPRPworks–myevidence-basedconclusion–byquoting

somepeer-reviewedscientificstudies.

Whatareplatelets?

Plateletsareabloodcomponentwhosemainfunctionistostopbleeding.Weallhave

platelets.Itturnsoutthatplateletsalsohavegranulesthat,whenactivated,release

morethan10growthfactors(GFs)thatnotonlyattractmoreplateletstotheareabut

alsostimulatesnewcollagenproductionandmanyotherprocessesthatarebeneficial

tohealingandhealthyyouthfulskinappearance.“Plateletderivedgrowthfactors’main

functionsaretostimulatecellreplication(mutagenesis)ofhealingcapablestemcells.”

(1)Plateletscontainαgranules,whichcomprisecytokines,growthfactorsandbioactive

proteinsessentialfortissuerepairandhealing.

WhatisPRPtherapy?

“Inrecentyears,autologousplatelet-richplasma(PRP)hasbeenproventopromote

woundandsofttissuehealingandcollagenregeneration.”(2)Thisprogressivenon-

surgicalhealingtreatment“hasbeenusedsuccessfullyinorthopedic,vascular,oraland

maxillofacialprocedures,aswellascosmeticskinimprovement.(4)Ithasalsobeen

usedinOphthalmologyforyearstospeedepithelialwoundhealingofthecornea.

“BecausePRPalsoenhancessofttissuemucosalandskinhealing,itisusedin

connectivetissuegrafts,palatalgrafts,gingivalgrafts,mucosalflapstogetherwith

Alloderm(BioHorizons,Birmingham,AL)forrootcoverage,skingraftdonorand

recipientsites,dermalfatgrafts,facelifts,blepharoplasty,andlaserresurfacing

surgery.”(8)

IntrotoPRP,RichardWeissMD 2

PRPcontainsgrowthfactorsthathaveauniqueroleinstimulatingbiochemical

pathwaysthatpromoteskinrepairandregeneration.PRPiswidelyusedinaesthetics,

wherethenaturalcomponentsofthebodyareharnessedtopromoteskinrejuvenation.

Bystimulatingcollagen,elastinandcellulargrowth,aswellasbyimprovinglocalblood

supplyandhydration,theskintextureandtoneshouldgraduallyimproveandleadtoa

youngerlookingskin.

Thistreatmentcanimproveskintextureandtone,refinewrinklesandreducescarssuchasacneorstretchmarkswhilepreservinganaturalappearance.

“Skinagingisacommonandcomplexbiologicalprocess,characterizedbywrinkles,

epidermalanddermalatrophy,roughtexture,pigmentation,telangiectasia,andskin

laxity.PRPplaysavitalroleintheprocessofwoundhealingthroughsecretionofalarge

numberofgrowthfactors(GFs).Thesecanstimulatecellularmigration,proliferation,

andangiogenesis.PRPasanaturalreservoirofGFs,isabletofacilitatecollagenof

fibroblasts,keratinocyteproliferation,andhyaluronicacidgenerationtoincrease

dermalelasticity,andmayhaveapositiveeffectinfacialrejuvenation.Weinferredthat

usingPRPinultra-pulsedfractionalCO2lasertherapymayacceleratetissuerepairand

relievepain.”(2)

Bystimulatingcollagen,elastinandcellulargrowth,aswellasbyimprovinglocalbloodsupplyandhydration,theskintextureandtoneshouldgraduallyimproveandleadtoayoungerlookingskin.

HowdoesCO2LaserSkinResurfacingwork?

Thelaserisabeamoflightthatisabsorbedbywatermoleculesinourskincells.When

thewaterabsorbsthelightfromthelaser,itheatsupandthewaterisvaporized.The

heatalsocausescollagentighteningandstartstheprocessofnewcollagenformation.

“Ultra-pulsedfractionalCO2lasercanpromotefibroblastsmetastasis,andcollagen

regenerationthroughcreationofMTZ[micro-thermalzones].ThethermaleffectofMTZ

maynotonlyinducehyperplasiaandreorganizationofcollagenfibers,butalso

acceleratetissuerecoverybydirectlyvaporizingpigmentgrouporpigmentcells,

acceleratingskinmetabolism,andpromotingtheregenerationofdermisandepidermis,

therebyreducingoreliminatingmildtomoderatewrinkles,improvingskintextureand

color,shrinkingpores,andrelievingskinflabbiness,achievingtheimmediateandlong-

termeffectoffirmingskin.”(2)

“CO2devicesheattissuemuchmoreintenselythannon-ablativefractionateddevices,

ablatingepidermalanddermaltissuewithsignificantheatingoftheimmediately

adjacentdermalcollagen.Thiscollateralheatingcausesthermalalterationsinthe

helicalstructureofthecollagenfibrilsandresultsintissueshrinkagefollowedby

collagenremodelingandskintightening.”(5)

IntrotoPRP,RichardWeissMD 3

WhatarethebenefitsofPRPtomypatients?

“Whileittakessixweeksfornewcollagensynthesisandaboutsixmonthsforthefull

effectofthetreatments,thecommonresponsebypatientsaftertheinitialtreatmentis

thattheirskinhasa“glow”andfemaleswearlessmake-upandfeelmorecomfortable

whentheyarenotwearingmake-up.”(1)

What’stheevidencethatPRPworks?

1- “FibroblastsareamongthecellsthatareactivatedbyTGF-beta.Whenafibroblastisactivateditwillundergocelldivisionandproducecollagen.

Collagendepositionisresponsibleforplumpingtheskinandreversingthe

visiblesignsofaging.”(1)

2- “OnthePRP-treatedside,theepidermisisthicker,andthestratumcorneumisbetter-organizedthaninthecontrolspecimen,andthecollagendensityishigher,

withbetterorganizationofthethickercollagenfiberbundles.”(5)

3- “Insummary,theresultsofthepresentstudystronglysuggestthattheapplicationofautologousPRPcouldbeaneffectivemethodforenhancing

woundhealing,reducingtransientunwantedadverseeffects,andimprovingskin

tighteningafter…skinrejuvenation.”(5)

IntrotoPRP,RichardWeissMD 4

Summaryofselectedscientificstudies

Study1-In14patientstreatedwithlaserskinresurfacingandPRPonjustoneside,therewasroughlya10%improvementinpatientsatisfactioninfacialwrinkles,skin

textureandskinelasticity.“Patientintheexperimental(PRP)grouphadafaster

recovery,lessdurationofadverseevents,andbettereffectsthanthatinthecontrol

group.Intheprocessoftreatment,patientsfeltthatanydiscomfortcausedbylaser

therapywasrelievedbycoatingwithPRP.”(2)Subjectivescoresoffacialwrinkles,skin

texture,andskinelasticitywerehigherthanthatincontrolgroup.Additionally,thetotal

durationoferythema,edema,andcrustingwasdecreased.Synergisticeffectonfacial

rejuvenation,shorteningdurationofsideeffects,andpromotingbettertherapeutic

effect.”(2)

Study2–23consecutivepatients(agerange28-70,average47)weretreatedwith3monthlyPRPinjectionsalone.(3)Whenevaluatedonemonthafterthelastsessionwith

stateoftheartcomputerassistedphotography,therewasanoverall29%improvement

intheappearanceoftheskin.Facialscarsincludingacnescarsrespondedwell.Patient

satisfactionquestionnaireresults:

Doyouthinkyourgenerallookhasimproved? 87%YES

Doyouthinkyourwrinkleshaveimproved? 52%YES

Doyouthinkyourskintonicityhasimproved? 82%YES

Pleaserateyoudegreeofsatisfactionwiththetreatment?

Excellentimprovement 0%

Verygoodimprovement 4%

Goodimprovement 61%

Mildimprovement 30%

Noimprovement 4%

Caption:Dermacopecheekphotobeforeandafter3monthlyPRPtreatments

IntrotoPRP,RichardWeissMD 5

Caption:Scartreatmentbeforeandafter3monthlyPRPtreatments

Study3–FourpatientsweretreatedwithPRPonceintheupperarm,andthenhadskinbiopsiesovera10-weekperiod.“Histologically,at1week,activatedfibroblasts,new

collagendeposition,andangiogenesisinthemid-todeepdermiswasevidentandwere

accompaniedbyfocalareasofmildlymphocyticinfiltrates”(4)

“Asearlyas7daysaftertreatment,activatedfibro-blastsandnewcollagen

depositionwerenotedandcontinuedtobeevidentthroughoutthecourseofthestudy.

Developmentofnewbloodvesselswasnotedby19days;alsoatthistime,intradermal

collectionsofadipocytesandstimulationofsubdermaladipocytes.”(4)

Study4-FractionalskinresurfacingwasperformedontheinnerarmsandsingletreatmentPRPwasinjectedononesideonly.Biopsiesweretakenfrom5patients.The

skinhealedfasterandtherednesswentawaymorequicklyonthePRPside.Also,

thickercollagenbundleswereseenonthePRPtreatedsideatonemonth.“Theresults

inthepresentstudydemonstratedthatfasterwoundhealingafterlasertreatment

couldalsobeachievedwiththeapplicationofPRP.”(5)

Caption:Noticethethickerepidermiswithabetter-organizedstratumcorneumonthe

PRPside

IntrotoPRP,RichardWeissMD 6

Study5–Sclafani-15patientshadasinglePRPinjectiontothenasolabialfoldswitheasilyseenphotographicresultscontinuingfor3monthsaftertreatment.(6)Hereisa

patientwhounderwentsingletreatmentofnaso-labialfoldswithPRP,(a)

Pretreatment;(b)2weeksaftertreatment.

A–Pretreatment(beforeanytreatment)

B–2weeksaftersinglePRPtreatment

Study6–Shin-22Koreanwomenunderwent3sessionsoffractionallaser.HalfwerealsotreatedwithPRP.“PRPcombinedwithfractionallaserincreasedsubject

satisfactionandskinelasticityanddecreasedtheerythemaindex.PRPalsoincreased

theamountofcollagenandthenumberoffibroblasts.”(7)

Study7–Zenker–Thispapersummarizedtheresultsofenlisted172patientsinJapan(38-72years),194patientsintheU.K.(42-79years),and42patientsinIsrael(46-74

yearsofage).“PRPisaformofbiostimulationthatissafeandcreatesanimmediate

longlastingvolumetriceffectwithnaturallookingresults…andprovidedahighlevelof

patientsatisfaction.”(9)

IntrotoPRP,RichardWeissMD 7

Conclusions:

“Platelet-richfibrinmatrixinjectionleadstodevelopmentofnewbloodvessels,

activationoffibroblastswithneocollagenesisandadipogenesiswithinthedermis”(4)

“ApplicationofautologousPRPisaneffectivemethodforenhancingwoundhealingand

reducingtransientadverseeffectsafterFxCRtreatment.”(5)

PRP“canprovidesignificantlong-termdiminutionofdeepNLFswithouttheuseof

foreignmaterials.PRFMholdssignificantpotentialforstimulateddermalaugmentation.”

(6)

“PRPwithfractionallasertreatmentisagoodcombinationtherapyforskin

rejuvenation.Keratinocyteandfibroblastproliferationandcollagenproductioncan

explainthecapacityofPRPtoincreasedermalelasticity.”(7)

Summary

TheaboveevidencestronglysuggeststhatPRPworks.However,morestudiesare

neededtodeterminetheoptimalamountoftreatmentsneededandhowlongthe

resultslast.Fornow,though,PRPisawelcomeadditiontoourrejuvenationtreatments.

RichardWeiss,MDMarch14,2017

REFERENCES

1. Greco,J."Microneedlingandinjectingplateletrichplasmatoenhancecollagensynthesisandskintightening."(2008).

2. Hui,Qiang,etal."TheClinicalEfficacyofAutologousPlatelet-RichPlasmaCombinedwithUltra-PulsedFractionalCO2LaserTherapyforFacial

Rejuvenation."Rejuvenationresearch(2016).

3. Redaelli,Alessio."FaceandneckrevitalizationwithPlatelet-richplasma(PRP):clinicaloutcomeinaseriesof23consecutivelytreatedpatients.(ORIGINAL

ARTICLES)(Clinicalreport)."JournalofDrugsinDermatology(2010).

4. Sclafani,AnthonyP.,andStevenA.McCormick."Inductionofdermalcollagenesis,angiogenesis,andadipogenesisinhumanskinbyinjectionofplatelet-richfibrin

matrix."Archivesoffacialplasticsurgery14.2(2012):132-136.

5. NA,JUNG-IM,etal."Rapidhealingandreducederythemaafterablativefractionalcarbondioxidelaserresurfacingcombinedwiththeapplicationofautologous

platelet-richplasma."DermatologicSurgery37.4(2011):463-468.

6. Sclafani,AnthonyP.,andYushanLisaWilson."Plateletrichfibrinmatrixforimprovementofdeepnasolabialfolds."TheLaryngoscope119.S3(2009).

7. Shin,Min-Kyung,etal."Platelet-RichPlasmaCombinedwithFractionalLaserTherapyforSkinRejuvenation."DermatologicSurgery38.4(2012):623-630.

8. Marx,RobertE."Platelet-richplasma:evidencetosupportitsuse."Journaloforalandmaxillofacialsurgery62.4(2004):489-496.

9. S.Zenker.“Plateletrichplasma(PRP)forfacialrejuvenation.”JMedEsthetChirDerm.37:148,December2010,179-183.Munich,Germany