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ELOIDS, HYPERTROPHIC SCARS, AND ATROPHIC SCARS ARE DISORDERS WITH altered dermal matrix deposition and these are a common sequela from loss of collagen and elastic fibres after inflammatory processes. The disfigurement may have a negative affect on the quality of life for many patients. Various therapies have been employed in treating scars, including noninvasive and invasive methods, such as corticosteroids, silicone gels, and autologous fat
grafting. The research on new therapeutic approaches has led to the advancements of different lasers for improving every scar type with variable outcomes. Current ablative devices have a significantly greater potential depth of thermal injury compared with the non-ablative type. Ablative lasers are indicated more for the treatment of hypertrophic scars, while also being effective for treatment of atrophic or flat, mature scars. Fractional laser therapy induces varied biological effects into the tissue, stimulating the dermis to produce new collagen and it is associated with a relatively low rate of complications, especially compared with full-field ablative devices. A current novelty in the treatment of scars is the association of fractional laser systems with new
devices: with platelet-rich plasma (PRP) and with the fat grafting and percutaneous aponeurotomy. PRP is plasma with a higher concentration of platelets than normally found. The a-granules of the platelets release growth factors in response to platelet activation, and stimulate cell proliferation and cell differentiation for tissue regeneration. These growth factors have an important role in the regulation and proliferation of mesenchymal cells, including fibroblasts, and have been shown to reduce healing time and improve the likelihood of complete wound healing. In our experience, the injection of PRP in the scar tissue was followed by an immediate fractional laser CO2
session
because activated PRP promoted the proliferation of human adipose derived stem cells and human dermal fibroblasts; the following thermal effect of the laser stimulated a therapeutic wound healing response with production of heat-shock proteins, myofibroblasts, and increased collagen III, and therefore has potential application in texture remodelling. On the other side, the discovery of a high content of stem cells (adipose mesenchymal stem cells,
AMSC) inside the grafted fat, has revolutionized the approach to this technique. The percutaneous aponeurotomy consists in transforming the scar into a neomatrix scaffold, where the grafted fat may homogenously spread and act. This technique consists of creating a fractional CO2
passage on the
scar, followed by a technique called ‘Rigottomy’, where the creation of multiple cuts and holes in all the directions and planes of the scar transforms it into a neomatrix scaffold. After this phase it is possible to ‘prepare’ the scar, loosening and expanding this tissue for receiving the fat grafting by accurately injecting only few microlitres at a time inside these little holes of the scar1–3
.
Prof. Paolo Bonan Dermatologist Florence, Italy
PRIME JOURNAL EDITORIAL BOARD BOARD MEMBER SPECIALISM
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BOARD MEMBER SPECIALISM Dr Gustavo Leibaschoff
Dr Sohail Mansoor Prof Leonardo Marini Dr Sly Nedic
Prof Daniel Pella
Cosmetic Surgery Dermatology Dermatology
Dr Chariya Petchngaovilai Dermatology Prof Ascanio Polimeni Dr Herve Raspaldo
Dr Christopher Rowland-Payne Dermatology Dr Neil Sadick
Dr Hema Sundaram Dr Pakpilai Thavisin Dr Patrick Treacy Dr Mario Trelles Dr Ines Verner Dr Octavio Viera
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prime-journal.com | March 2015 5 ❚
1. Zhu JT, Xuan M, Zhang YN, et al. The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne. Mol Med Rep 2013; 8(1): 233-7 2. Metelitsa AI. Commentary: autologous platelet-rich plasma with fractional laser resurfacing. Dermatol Surg 2011; 37(4): 469 3. Khouri RK, Smit JM, Cardoso E et al. Percutaneous aponeurotomy and lipofilling: a regenerative alternative to flap reconstruction? Plast Reconstr Surg 2013; 132(5): 1280-90
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