| FACIAL AESTHETICS | PEER-REVIEW compared with controls18 . Other reviews on PRP
therapy have reached the same conclusions. One systematic review went so far as to conclude that,
based on the meta-analysis and scientific evidence regarding consistent favourable outcomes, PRP is a treatment of choice for the topical care of wounds33
. A
total of 15 randomised controlled trials and 25 case-control studies were found. Thirty-six publications demonstrated favourable outcomes with the use of PRP. The included articles were divided into three topics related to cosmetic surgery: wound healing, fat grafting and bone grafting. Carter et al33
described a substantially beneficial effect of
PRP for a number of indications, including a better wound healing rate, an increased survival rate of fat grafts, and an enhancement of bone graft regeneration.
Tissue remodelling Autologous PRP has attracted attention in a number of medical fields. In one study34
, the effects of activated PRP
(aPRP) and activated platelet-poor plasma (aPPP) were investigated with regard to the remodelling of the extracellular matrix (ECM), a process that requires activation of the dermal fibroblasts — essential for the rejuvenation of aged skin. aPRP AND aPPP both stimulated cell proliferation, with peak proliferation occurring in cells grown in 5% aPRP. Additionally, aPRP and aPPP increased the expression of type I collagen, MMP-1 protein, and mRNA in human dermal fibroblasts. aPRP and aPPP promote
tissue remodelling in aged skin and may be used as adjuvant treatment to lasers for skin rejuvenation in cosmetic dermatology. Although the optimal platelet concentration is unclear, the current methods by which PRP is prepared is reported to involve approximately 300–700% enrichment, with platelet concentrations consequently increasing to greater than 1 000 000 platelets35
. These
factors are known to regulate processes including cell migration, attachment, proliferation and differentiation, and promote ECM accumulation by binding to specific cell surface receptors36
. In the dermis, which is continually exposed to UVB,
collagen degeneration and altered deposition of elastic tissue result in the impairment of the structural integrity of the dermal ECM, causing the skin to wrinkle. The skin’s resilience is also reduced. Compared with the serum-treated control group in one study37
, aPRP and
aPPP showed a marked increase in fibroblast proliferation. Cells exposed to 5% or 10% aPRP also exhibited significantly higher rates of proliferation than positive control cells. These results indicate that aPRP and aPPP promote the proliferation of fibroblasts. On the other hand, the expression of the a1 and a2 chains of type I collagen was increased in cells treated with 5% aPRP or aPPP (compared with negative control), suggesting that both PRP and PPP show an ability to induce collagen production.
This stimulation of de novo collagen synthesis may PRP combined with fractional laser was found to
increase patient satisfaction and skin elasticity, and decrease the erythema index.
deposition of new collagen38
compensate for the defects that arise as a result of the fragmentation or loss of collagen in photoaged and aged skin. Accumulation of this newly-synthesised collagen may improve the structural integrity of the dermal ECM and stimulate fibroblasts to produce more collagen. Similarly, induction of MMP-1 in photoaged skin may facilitate the removal of collagen fragments that damage the dermal matrix tissue, thus providing a better foundation for the . In a more recent
study, injection of PRP in the face and neck for revitalisation obtained good results39
.
PRP treatment results PRP combined with fractional laser was found to increase patient satisfaction and skin elasticity, and decrease the erythema index40
. Furthermore, treatment increased
the length of the dermo–epidermal junction, the amount of collagen, and the number of fibroblasts. PRP with fractional laser treatment is a good combination therapy for skin rejuvenation. Keratinocyte and fibroblast proliferation and collagen production can explain the capacity of PRP to increase dermal elasticity. In a study to evaluate the efficacy of a single
injection of autologous platelet-rich fibrin matrix (PRFM) for the correction of deep nasolabial folds (NLFs), whole blood was obtained from 15 adults, and an activated autologous platelet-rich fibrin matrix produced using a proprietary system1
Figure 2 (A) Before and (B) after treatment with platelet-rich plasma
. It was
then injected into the dermis and immediate subdermis below the nasolabial folds. Subjects were photographed before and after treatment; folds were rated by the
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