Platelet rich plasma for photodamaged skin: A pilot study

Systematic Review of Platelet-Rich Plasma and Platelet-Rich Fibrin in Facial Rejuvenation

BACKGROUND

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are promising treatments for facial rejuvenation, leveraging growth factors to stimulate natural tissue repair and regeneration. Despite their growing popularity, their effectiveness remains controversial, with studies yielding mixed results. This systematic review evaluates the current evidence on PRP/PRF therapies and their effect on the following 6 key parameters of facial aging: wrinkles, texture, dyschromia, elasticity, skin thickness, and hydration.

METHODS

A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases for controlled trials, prospective cohort studies, and case series published after 2010. Eligible studies included more than 5 patients, evaluated PRP or PRF as monotherapy, and addressed at least 1 of the 6 listed parameters of facial aging. Articles were screened by 2 independent investigators and scored for quality of evidence using the Oxford Centre for Evidence-Based Medicine hierarchy.

RESULTS

Twenty articles, comprising 514 patients, met inclusion criteria. Sixteen studies compared PRP/PRF to a control or baseline, while 4 compared them to alternative treatments. Wrinkles and fine lines (n = 16) were the most frequently studied parameters, followed by dyschromia (n = 12), texture (n = 11), elasticity (n = 6), skin thickness (n = 5), and hydration (n = 4). Significant improvements following PRP/PRF treatment were reported in 80% of studies on skin thickness, 75% on elasticity, 40% on wrinkles, 33% on texture, 17% on dyschromia, and 0% on hydration. Skin dyschromia had the highest proportion of studies reporting mixed findings (41.7%), whereas skin hydration had the highest proportion of studies reporting no improvement (67%). Additionally, all studies evaluating patient satisfaction reported significant improvements from pretreatment to posttreatment. No serious adverse events were reported in any of the included studies.

CONCLUSIONS

This systematic review identified skin thickness and elasticity as the facial aging parameters with the strongest evidence of improvement following PRP/PRF treatment, while skin hydration showed the weakest.

The Role of Platelet Concentrates and Growth Factors in Facial Rejuvenation: A Systematic Review with Case Series

Background and objectives: Due to the regeneration potential of growth factors (GFs) and platelet concentrates (PCs), facial rejuvenation has been a major area of attention in esthetic medicine. The effectiveness and safety of PCs and GFs in promoting face rejuvenation are examined in this systematic review, which is complemented by a case series. GFs are essential for collagen production and dermal matrix remodeling, while PCs, like Platelet-Rich Plasma (PRP), are abundant in bioactive chemicals that promote tissue healing and cellular regeneration. Materials and Methods: A comprehensive literature search was performed on PubMed, Web of Science, and Scopus, focusing on human clinical trials published between February 2019 and February 2024 related to PRP and facial esthetics. Results: Thirteen studies met the inclusion criteria and were analyzed. Conclusions: The review summarizes the most recent data on patient outcomes, treatment regimens, and possible hazards. The case series that goes with it shows real-world examples of how to improve skin elasticity, texture, and general facial appearance with little negative side effects. These results highlight the potential use of PCs and GFs as minimally invasive procedures.

Clinical evaluation of combined autologous Platelet-Rich Plasma and Volume-Controlled Ozone Therapy in Facial Rejuvenation: A randomized controlled Pilot Study

Platelet rich plasma and ozone therapy have been suggested in the clinical setting as promising and adjuvant therapies for managing the symptoms related to the facial aging. However, there is a lack of evidence about the effects of combining both therapies on rejuvenation. Thus, the aim of the present study was to evaluate and to compare the safety and efficacy of both therapies in facial aging. A single-center prospective pilot study was conducted. Female participants, aged 40 to 60 years, were randomized into 2 groups: participants received the platelet rich plasma treatment (PRP); participants received the therapy with platelet rich plasma associated with ozone therapy (PRPOT). Interventions were performed using the facial intradermal technique in 42 pre-established points, for 4 sessions with an interval of 15 days between them. After analyses performed using photographic records, assessment of frontal, periorbital, nasolabial and marionette wrinkles (Wrinkle Assessment Scale), self-esteem assessment (Brazilian Version of Rosenberg's Self-Esteem Scale) and assessment of patient satisfaction (FACE-Q) can be suggested that the platelet rich plasma protocol performed in the present study, as well as its association with volume-controlled ozone therapy, proved to be safe and potentially promising modalities in the treatment of facial aging.

The Biological Role of Platelet Derivatives in Regenerative Aesthetics

Bioproducts derived from platelets have been extensively used across various medical fields, with a recent notable surge in their application in dermatology and aesthetic procedures. These products, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), play crucial roles in inducing blood vessel proliferation through growth factors derived from peripheral blood. PRP and PRF, in particular, facilitate fibrin polymerization, creating a robust structure that serves as a reservoir for numerous growth factors. These factors contribute to tissue regeneration by promoting cell proliferation, differentiation, and migration and collagen/elastin production. Aesthetic medicine harnesses these effects for diverse purposes, including hair restoration, scar treatment, striae management, and wound healing. Furthermore, these biological products can act as adjuvants with other treatment modalities, such as laser therapy, radiofrequency, and microneedling. This review synthesizes the existing evidence, offering insights into the applications and benefits of biological products in aesthetic medicine.

The emerging role of biostimulators as an adjunct in facial rejuvenation: A systematic review

INTRODUCTION

Facial aging has long been an area of focus in esthetic surgery. It is the consequence of physiologic and environmental factors, with a trend toward non-surgical modalities. Although volume augmentation has long been a focus of non-surgical facial rejuvenation, there is emerging interest in the use of biostimulators to induce physiologic changes in the skin. This article aimed to provide an overview of this class of therapies.

METHODS

A systematic review regarding the clinical use of biostimulatory agents including platelet-rich plasma (PRP), platelet-rich fibrin (PRF), poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) in facial rejuvenation was performed using PubMed databases. The protocol was developed following the preferred reporting for items for systematic reviews-protocols guidelines. Included studies matched predetermined criteria according to the employed intervention and outcomes.

RESULTS

The systematic review was performed in September 2023, with the primary search yielding 464 articles. Abstract review resulted in 73 articles of potential relevance. Comprehensive review of the articles and manual reference checks were performed, independently, by 2 authors. This yielded a total of 45 articles that met the inclusion criteria.

CONCLUSIONS

There is an increasing role for non-surgical modalities in facial rejuvenation. Biostimulatory agents may be used as an alternative, or act as an adjunct, to other non-surgical modalities. These agents induce physiologic changes that mitigate facial aging. There is limited, quantifiable data, which fully illustrate the effect in these products. Although these agents are known to illicit inflammatory changes, more controlled studies are needed to better elucidate the biostimulatory capacity of such non-surgical treatments.

Use of platelet rich plasma for skin rejuvenation

OBJECTIVE

Platelet-rich plasma (PRP) is recognized as a safe and effective therapy for regenerative skin healing and rejuvenation, utilizing autologous blood enriched with various growth factors. This review aims to assess the efficacy of PRP treatments for skin rejuvenation.

METHODS

Keywords such as "platelet-rich plasma," "rejuvenation," "skin aging," and "wrinkles" were queried on Ovid, PubMed, and MEDLINE to identify pertinent studies on PRP treatment for skin rejuvenation.

RESULTS

Analysis revealed that PRP treatment led to significant enhancements in multiple facial parameters after one to three sessions. Improvements were noted in skin pore size, texture, wrinkle reduction, pigmented spots, collagen density, hyaluronic acid levels, and protection against ultraviolet damage. Combining PRP with hyaluronic acid demonstrated a synergistic effect, particularly enhancing skin elasticity in patients with lower body mass index and firmness in individuals aged 50s and 60s. Incorporating both physical and biometric data for assessment proved superior to relying solely on physical observations for evaluating subtle skin quality and structural changes.

CONCLUSION

This study underscores the efficacy of PRP monotherapy for skin rejuvenation and emphasizes the necessity of standardizing PRP preparation protocols in future investigations. Heightened awareness and advancements in technology have contributed to the emergence of higher-quality, less biased studies supporting PRP as a reliable and safe therapeutic option for skin rejuvenation.

A bibliometric analysis of trends in the application of platelet-rich plasma in cosmetics research between 2001 and 2022

BACKGROUND

Several studies have been conducted on using platelet-rich plasma (PRP) to treat cosmetic issues. Nonetheless, no bibliometric analyses of publications in this field exist. Bibliometrics is an effective tool for methodically assessing the current state of research on a particular topic. This study examines the literature published in this field since 2000 and depicts the resulting network.

METHODS

The Web of Science Core Collection was searched for any publications mentioning the use of PRP in cosmetic or aesthetic therapy published between 2001 and 2022. The author, region, institution, journal, cited journal, and keywords were extracted, and the bibliometric analysis was carried out using CiteSpace and R studio.

RESULTS

There were a total of 306 items retrieved. The first publication in this field appeared in 2001, and the number of articles published increased over the next 21 years. Saedi Nazanin is the author with the most publications. The most prolific nations and institutions were the United States and the Fourth Military Medical University, respectively. Similarly, most articles and citations were found in the Journal of Cosmetic Dermatology and Plastic and Reconstructive Surgery. After performing a cluster analysis on the keywords of published publications, we discovered that most of the published literature focused on using PRP in rejuvenation, mechanism, and combination with MSCs. These topics are still at the frontier of future research.

CONCLUSION

Since the first study in this field was published in 2001, PRP used in cosmetic clinics has been studied. Although early effects have been observed, numerous challenges remain, including a lack of higher-quality clinical studies and explanations of PRP's mechanism. The bibliometric analysis conducted for the purpose of this article provides a summary of academic hotspots and research frontiers, as well as insights and pointers for future productive research.

Does Platelet-Rich Plasma Promote Facial Rejuvenation? Revising the Latest Evidence in a Narrative Review

Facial aging is characterized by progressive macroscopic, histological, and molecular changes. Due to its regenerative and rejuvenating properties, the use of platelet-rich plasma (PRP) as a facial antiaging agent has gained popularity over the last decade. In order to gather and evaluate the latest evidence focusing on the effect of PRP on facial skin rejuvenating, a search through MEDLINE (PubMed) using relevant keywords, inclusion, and exclusion criteria was performed. A total of 539 articles were initially retrieved, and from those, 16 were included in the review. Treatment protocols comprised the use of PRP both in monotherapy and in combination with other substances and by means of direct injection or topical application following skin permeation. The selected studies presented high variability regarding PRP preparation methods, administration protocols, and results assessment. In most studies, PRP seemed to improve to some degree the signs of facial aging, such has wrinkles, skin quality, and pigmentation, accompanied by significant histological and molecular responses. Optimizing treatment protocols should be the next step in assessing the full potential of PRP.

Best Practices for FACE-Q Aesthetics Research: A Systematic Review of Study Methodology

BACKGROUND

The FACE-Q Aesthetics module is a validated patient-reported outcome measure (PROM) that evaluates perspectives on facial aesthetic treatments. Improper administration and poor study methodology can compromise the validity and interpretation of this PROM.

OBJECTIVES

This systematic review sought to evaluate the administration and scoring of the FACE-Q Aesthetics scales within the literature.

METHODS

A search of Ovid Medline, Embase, Cochrane, and Web of Science was performed on December 20, 2022, with the assistance of a health-research librarian (CRD42022383676). Studies that examined facial aesthetic interventions using the FACE-Q Aesthetics module as a primary or secondary outcome measure were included for analysis.

RESULTS

There were 114 studies included. The Face Overall (n = 52, 45.6%), Psychological (n = 45, 39.4%), and Social (n = 43, 37.7%) scales were most frequently reported. Errors in FACE-Q administration were identified in 30 (26.3%) studies. The most common error was the presentation of raw ordinal scores rather than the converted Q score (n = 23). Most studies reported a time horizon for their primary analysis (n = 76, 66.7%); however, only 4 studies provided a rationale for this selection. Sample size calculations for the primary outcome were rarely performed (n = 9, 7.9%).

CONCLUSIONS

There continues to be limitations in PROM administration and the quality of articles that report FACE-Q Aesthetic scale data. The authors suggest that future investigators using the FACE-Q refer to the User's Guide regarding administration and scoring of this scale, report a rationale for the study time horizon, and provide an a priori sample size calculation for the primary outcome of interest.

Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives

With the increasing understanding of the aging process and growing desire for minimally invasive treatments, injectable fillers have great potential for correcting and rejuvenating facial wrinkles/folds and contouring the face. However, considering the increasing availability of multiple soft tissue fillers, it is important to understand their inherent biophysical features and specific mechanism. Thus, in this review, we aim to provide an update on the current injectable filler products and analyze and compare their critical physicochemical properties and function mechanisms for volume-filling. Additionally, future trends and development processes for injectable fillers are also proposed.

Dermatological Management of Aged Skin

The subject of the work concerns the dermatological management of patients mainly with aged skin. The purpose of the work was to present the basic techniques and preparations which are performed by dermatologists in the treatment of aged skin. There are dermatological treatments related to the treatment of skin diseases and cosmetic treatments which are mainly related to skin care. In this work, the method of literature research was applied. On the basis of books and journal articles on dermatological and cosmetic procedures for aged skin, an analysis of treatment types was made. Then, the results of this analysis were presented in the paper under discussion. The paper presents information on the skin and its properties. The structure and functions of the skin, aging processes and characteristics of aged skin were discussed. Then, the possibilities of reducing the visible signs of skin aging through the use of invasive and non-invasive dermatological and cosmetological treatments were given, and the most important components of preparations used supportively in combating skin aging processes were discussed.

Study of platelet-rich plasma application for skin and plastic surgery in recent 20 years: A bibliometric analysis

BACKGROUND

In recent years, platelet-rich plasma (PRP) has been used in plastic surgery, dermatology, and other treatment procedures worldwide. Since the number of scientific writings has been significantly increasing, it is challenging to generate a manual compilation and systematic review of PRP's therapeutic applications in dermatology and plastic surgeries. This study aimed to make a bibliometric analysis of the literature in the field and evaluate research hotspots and frontiers in this field in the past 20 years.

METHODS

Using the Academic Search Premier and ScienceDirect defined search terms, we searched the Web of Science Core Collection (WoSCC) and Scopus databases. All data were analyzed using CiteSpace 5.8.R3 and VOSviewer, including countries, institutions, authors, keywords, cited authors, cited journals, cited references, discovered research hotspots, and frontiers.

RESULTS

A total of 1931 studies were retrieved. The number of publications on PRP application in dermatology and plastic surgeries showed a yearly increase. The United States was the most significant contributor to this field, while Italy's contribution was noteworthy. The journal with the highest number of relevant articles in dermatology and plastic surgery included the Journal of Cosmetic Dermatology. However, the Wound Repair and Regeneration and International Journal of Molecular Sciences were the leading journals that should be paid attention to in the future. Author Anitua E from the Tor Vergata University of Rome published the most publications in this field. In the keyword co-occurrence analysis, all keywords were divided into six clusters, and the most common one in recent years was "PRP for facial beauty." Facial rejuvenation, scar, and alopecia were the main hotspots and research trends in this field.

CONCLUSIONS

Based on the current global trends, the use of PRP in cosmetics and skin care is receiving increasing attention from researchers and clinicians. Recently, an increasing number of articles on PRP's application in skin tissue repair have been published in the United States and Italy. The number of studies on hair loss, facial rejuvenation, and scar management is increasing, suggesting that these subjects may become research hotspots for PRP in dermatology and cosmetic surgeries in recent years.

The Use of the FACE-Q Aesthetic: A Narrative Review

INTRODUCTION

In the past decade there has been an increasing interest in the field of patient-reported outcome measures (PROMs) which are now commonly used alongside traditional outcome measures, such as morbidity and mortality. Since the FACE-Q Aesthetic development in 2010, it has been widely used in clinical practice and research, measuring the quality of life and patient satisfaction. It quantifies the impact and change across different aspects of cosmetic facial surgery and minimally invasive treatments. We review how researchers have utilized the FACE-Q Aesthetic module to date, and aim to understand better whether and how it has enhanced our understanding and practice of aesthetic facial procedures.

METHODS

We performed a systematic search of the literature. Publications that used the FACE-Q Aesthetic module to evaluate patient outcomes were included. Publications about the development of PROMs or modifications of the FACE-Q Aesthetic, translation or validation studies of the FACE-Q Aesthetic scales, papers not published in English, reviews, comments/discussions, or letters to the editor were excluded.

RESULTS

Our search produced 1189 different articles; 70 remained after applying in- and exclusion criteria. Significant findings and associations were further explored. The need for evidence-based patient-reported outcome caused a growing uptake of the FACE-Q Aesthetic in cosmetic surgery and dermatology an increasing amount of evidence concerning facelift surgery, botulinum toxin, rhinoplasty, soft tissue fillers, scar treatments, and experimental areas.

DISCUSSION

The FACE-Q Aesthetic has been used to contribute substantial evidence about the outcome from the patient perspective in cosmetic facial surgery and minimally invasive treatments. The FACE-Q Aesthetic holds great potential to improve quality of care and may fundamentally change the way we measure success in plastic surgery and dermatology.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The role of allogeneic platelet-rich plasma in patients with diabetic foot ulcer: Current perspectives and future challenges

The frequency of chronic cutaneous wounds are sharply increasing in aging populations. Patients with age-related diseases, such as diabetes, tumors, renal failure and stroke are prone to soft tissue and skin injury, compounded by slowed healing in aging. Imbalance of wound inflammation, loss of growth factor secretion, and impairment of tissue repair abilities are all possible reasons for failed healing. Therefore, it is vital to explore novel approaches to accelerate wound healing. Platelet-rich plasma (PRP) as a cell therapy has been widely applied for tissue repair and regeneration. PRP promotes wound healing by releasing antimicrobial peptides, growth factors and micro-RNAs. Medical evidence indicates that autologous platelet-rich plasma (au-PRP) can promote wound healing effectively, safely and rapidly. However, its clinical application is usually restricted to patients with chronic cutaneous wounds, generally because of other severe complications and poor clinical comorbidities. Allogeneic platelet-rich plasma (al-PRP), with abundant sources, has demonstrated its superiority in the field of chronic wound treatment. Al-PRP could overcome the limitations of au-PRP and has promising prospects in clinical applications. The aim of this review is to summarize the current status and future challenges of al-PRP in chronic cutaneous wound management. We also summarized clinical cases to further describe the application of al-PRP for chronic wounds in clinical practice.

Autologous platelet concentrates for facial rejuvenation

Autologous platelet concentrates (APCs) are promising therapeutic agents in facial rejuvenation since they are a great source of cytokines, growth factors and other biologically active substances. Obtained from the patient’s blood, they have the advantages of reducing immunological reactions, making the procedure safer, well tolerated, with minimal adverse effects and lower cost. Currently, they are used for facial rejuvenation both in combination with microneedling and in mesotherapy techniques, as well as to treat facial acne scars, melasma and wounds after laser ablative treatments. This review summarizes current knowledge on the use of APCs, ranging from basic concepts related to their composition and mechanisms of action to up-to-date information on their clinical efficacy.

Platelet-Rich Plasma Facial Rejuvenation: Myth or Reality?

Platelet-rich plasma (PRP) rejuvenation's efficacy has been reported by numerous uncontrolled clinical case studies of inconsistent quality rather than large randomized and placebo-controlled trials. It was suggested that PRP could be considered as a valid anti-aging and rejuvenation treatment modality. The current literature review summarizes available evidence so far described in the literature with special critical attention to higher quality comparative studies published over the last 10 years. The few studies that could be retrieved and included in this review documented less favorable results. So far, there is no international consensus on clinical PRP use for esthetic rejuvenation. Whether a mix of growth factors does in fact generate a clinically significant more youthful look and whether PRP injections result in comparable or better rejuvenation than what can be expected from other simpler non-surgical modalities. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Platelet-Rich Plasma in Facial Rejuvenation: A Systematic Appraisal of the Available Clinical Evidence

Purpose

Platelet-rich plasma (PRP) is a promising noninvasive technique for facial rejuvenation. This systematic literature review aims to appraise the nature and quality of published evidence evaluating the effectiveness and safety of PRP in facial rejuvenation.

Patients and Methods

A systematic literature review was conducted with the search string “Platelet-rich plasma AND Facial rejuvenation” in PubMed and Embase. Clinical studies evaluating the outcomes after PRP-based facial rejuvenation either as monotherapy or in combination with other treatment modalities were included. Studies evaluating wound-healing properties of PRP were excluded. The outcomes included both patient-reported and physician-assessed outcomes. Nonstatistical synthesis of evidence was performed by qualitative assessment. The results are reported by the Synthesis Without Meta-analysis (SWiM) reporting standard.

Results

A total of 36 studies that included a total of 3172 patients were considered for the evidence synthesis. The number of patients in the included studies ranging from 11 to 2005 with a median of 27.5 patients that reflects the challenges in clinically assessing the aesthetic outcomes after PRP-based facial rejuvenation. Among the 36 studies, 17 were observational studies and 18 were interventional studies with 1 being case report PRP was evaluated either alone or in combination with hyaluronic acid, lipofilling, micro-needling technique, and laser-based interventions. Among the studies, 1 study reported the enhanced platelet concentrate in a fibrin matrix to be relatively safe and effective with a maximum benefit observed at 12 weeks suggesting the platelet-rich fibrin matrix may provide desired aesthetic outcomes and it requires further studies to substantiate.

Conclusion

The results suggest very limited clinical evidence, and further clinical studies are warranted to establish the effectiveness of PRP in facial rejuvenation. Furthermore, a consensus for end points used for establishing clinical utility in patients requiring facial rejuvenation is warranted.

What Is the Adequate PRP Dose for an Effective Treatment? An In Vitro Experimental Study on the Skin

BACKGROUND

The clinical results of many studies on platelet-rich plasma (PRP) differ due to a lack of standardization in PRP preparation and administration as well as many variables such as PRP preparation methods, platelet concentration, and platelet activation.

OBJECTIVES

The authors sought to investigate a different variable that will affect PRP application results. How much PRP should be injected into the unit area of tissue for an effective PRP treatment?

METHODS

The study was performed on fresh surplus tissues of 20 patients that were discarded in abdominoplasty and mammoplasty operations. Nine areas of 4 cm2 were marked on the skin. Fluorescein-stained PRP was injected intradermally with 3 different gauge needles at 3 different doses (0.01, 0.03, and 0.05 mL). After injections, spreads of the fluorescent dye-covered areas in horizontal and vertical planes were measured and compared. For the horizontal plane measurements, the dye spread was measured first from the surface of the skin and second from the dermal surface of the skin. In addition, the width and depth of the dye spread in the dermis were measured from vertical sections.

RESULTS

Changing the needle diameter does not affect the width or depth (thickness) of the PRP spread in the dermis. Increasing the applied dose to 0.03 mL increases the spread to the width and depth (thickness).

CONCLUSIONS

In research evaluating the effectiveness of PRP treatments, it is necessary to report the volume of PRP to be applied per unit of tissue.

The measurement of wound tensile strength and the effect of PRP on wound tensile force: an experimental investigation on rabbits

Platelets in PRP are used for their functions in the initiation and regulation of the wound healing process and are used for the repair of injured tissues and the rejuvenation of healthy tissues. In this study, we evaluated the effect of a single dose platelet-rich plasma on skin wound healing and we demonstrated the effect of platelet-rich plasma on skin wound healing by measuring changes in the wound tensile strength.Material and methods: A total of 8 incisions, each 3 cm long, were made on the back skin on both sides of the vertebral column of 12 rabbits. After suturing their backs with staples, platelet rich plasma (PRP) was injected into the edges of the wounds on the left side and saline solution (saline) was injected into the edges of the wounds on the right side. The tensile force that causes wounds to rupture by applying tension was measured on the 7th, 14th, 21st, and 28th days with the help of a special home-designed device.Results: The mean PRP enrichment was 3.19 fold over peripheral blood. The saline to PRP tensile strength ratios on the 7th, 14th, 21st, and 28th days were calculated as 75.7%, 104.0%, 105.3% and 86.5%, respectively. Overall, the difference in the tensile strength for wounds that had received saline or PRP was in-significant.Conclusion: The application of PRP increases the tensile strength of the wound in the early period. It is possible to measure the tensile strength precisely in in vivo studies with economical home-designed devices.

Platelet-rich plasma protects human melanocytes from oxidative stress and ameliorates melanogenesis induced by UVB irradiation

To investigate the role of platelet-rich plasma (PRP) from different sources in alleviating oxidative stress and ameliorating melanogenesis in UVB-irradiated PIG1 cells, PIG1 cells were irradiated with 80 mJ/cm2 UVB prior to 1% PRP application and the following experiments were taken: the viability of UVB-irradiated PIG1 cells, cellular malondialdehyde (MDA) and reactive oxygen species (ROS) content, and activities of antioxidant enzymes. Western blotting was utilized to detect the expression level of proteins associated with melanin synthesis, apoptosis, and DNA lesions. We found that PRP intervention promoted cell proliferation, reduced MDA and ROS content, increased the activities of series of antioxidant enzymes, and alleviated DNA damages in UVB-damaged PIG1 cells. It is important to note that PRP treatment inhibited UVB-induced melanogenesis via the PI3K/Akt/GSK3β signal pathway. Therefore, we suppose PRP treatment exerts a protective role through their antioxidation effect on UVB-damaged PIG1 cells and hinders melanogenesis induced by UVB irradiation.

Platelet-Rich Plasma: Evolving Role in Plastic Surgery

BACKGROUND

The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures.

METHODS

In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use.

RESULTS

Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities.

CONCLUSIONS

Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.

The effect of lyophilized platelet rich-plasma on skin aging: a non-randomized, controlled, pilot trial

Platelet-rich plasma (PRP) showed positive results in the improvement of skin aging. Lyophilized PRP can be interesting in clinical practice due to the facility to obtain many samples in a single blood collection and can be used in multiple injections. To evaluate the effect of lyophilized PRP in the treatment of skin aging, through a Phase II pilot study. Nineteen women (54 years ± 7 years) with Glogau photoaging II and III types were select for this non-randomized, split-face controlled study. They received monthly intradermal injections of lyophilized PRP and saline solution (as control) into the facial skin, during a period of 2 months. The evaluation was performed by imaging method, histological techniques, and multiphoton microscopy. Although lyophilized PRP presented 10 times the platelet baseline value (P < .0001) and growth factors in adequate levels, only saline solution showed an increase of dermis thickness (p = .0009). Collagen pre and post-application remained the same for both types of treatments. The use of lyophilized PRP by mesotherapy showed no improvement on skin aging. TRIAL REGISTRATION APPROVAL: RBR-3n9wxw, UTN U1111-1226-6093-retrospectively registered.

The Anti-photoaging Effects of Pre- and Post-treatment of Platelet-rich Plasma on UVB-damaged HaCaT Keratinocytes

Platelet-rich plasma (PRP) has seen wide clinical use owing to its regenerative and repair abilities.

OBJECTIVE

To investigate the anti-photoaging effects of pre- and post-treatment of PRP on UVB-damaged HaCaT cells.

METHODS

HaCaT cells were irradiated with 80 mJ/cm² UVB, before or after PRP treatment (1000 × 10⁷ /L), and following measurements were taken: survival rate of UVB-irradiated HaCaT cells, malondialdehyde (MDA) content and activities of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT). Western blot was used to determine the effect of different PRP intervention on the expression of PI3K, AKT, ERK, MMP-1, MMP-9, TIMP-1 and γ-H2AX in the UVB-irradiated HaCaT cells.

RESULTS

pre- and post-PRP treatment reduced MDA content and increased the activities of GSH-Px, SOD and CAT in photoaged HaCaT cells. These changes resulted in reduced cytotoxic effects. Besides, different PRP intervention promoted cell proliferation via PI3K/AKT pathway. Furthermore, PRP application suppressed the expression of γ-H2AX. Also, PRP intervention alleviated photoaging effects by upregulating the expression level of tissue inhibitor of metalloproteinases-1 (TIMP-1) while downregulating matrix metalloproteinase (MMP) expression level in photoaged HaCaT cells.

CONCLUSION

pre- and post-PRP treatment play anti-photoaging role through strengthening cellular oxidative defense capacity, mitigating MMP expression, alleviating DNA damages and promoting proliferation of UVB-irradiated HaCaT cells.

The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part II: Clinical Evidence

BACKGROUND

Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge.

OBJECTIVE

To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine.

MATERIALS AND METHODS

A two-part systematic review and expert analysis of publications before October 2018.

RESULTS AND CONCLUSION

Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly.

Injectable platelet-rich fibrin for facial rejuvenation: A prospective, single-center study

BACKGROUND

Autologous platelet-derived preparations have been used in many surgical fields to improve healing outcomes, with benefits reported in several aesthetic indications.

AIMS

This single-center, prospective, uncontrolled study evaluated the efficacy of injectable platelet-rich fibrin (i-PRF) for facial skin rejuvenation using an objective skin analysis system and validated patient-reported outcome measures.

PATIENTS/METHODS

PRF^® PROCESS system technology was used to prepare i-PRP. Eleven healthy female individuals were included in the study and over 3-months received monthly intradermal injections of i-PRF in 3 facial regions: malar areas (1 mL each side), nasolabial fold (0.5 mL each side), and upper lip skin above the vermilion border (1 mL). The efficacy of the procedures was assessed by objective skin analysis (VISIA^® ) and a subjective patient-reported outcome (FACE-Q) assessment at baseline and after 3 months.

RESULTS

A significant improvement in skin surface spots (P = .01) and pores (P = .03) was seen at 3-months follow-up. Other variables, such as skin texture, wrinkles, ultraviolet spots, and porphyrins, showed a numerical improvement. FACE-Q scales that measure satisfaction with appearance all showed a significant improvement from baseline, including satisfaction with skin (P = .002), satisfaction with facial appearance (P = .025), satisfaction with cheeks (P = .001), satisfaction with lower face and jawline (P = .002), and satisfaction with lips (P = .04). No major adverse effects were reported.

CONCLUSIONS

A series of three i-PRF injections resulted in significant rejuvenation of the face skin at 3-month follow-up, as shown by improved skin analysis parameters and patient self-assessment scores.

The Use of Platelet-Rich Plasma in Aesthetic and Regenerative Medicine: A Comprehensive Review

INTRODUCTION

In recent years, platelet-rich plasma (PRP) has emerged as a promising autologous biological treatment modality for the use in aesthetic and regenerative medicine. PRP is a high concentration of platelets derived from whole blood which is isolated by centrifugation to separate and concentrate platelet-containing plasma from red blood cells. PRP comprises hundreds of bioactive proteins, including growth factors, peptides, and cytokines that stimulate healing of skin and soft tissues. Attractive features of PRP are the extended release of various growth and differentiation factors from activated platelets, tissue regenerative, and healing capabilities, as well as the lack of problems associated with immunogenicity. Because of the unique biological features of this whole blood-derived biological agent, multiple clinical uses for PRP exist for aesthetic and regenerative medicine.

EVIDENCE ACQUISITIONS

A comprehensive review of the literature regarding the use of platelet-rich plasma in aesthetic and regenerative medicine was performed.

EVIDENCE SYNTHESIS

Therapeutic applications of PRP including several methods for its clinical deployment in conditions related to aesthetic and regenerative medicine including wound healing, skin and facial rejuvenation, hair restoration, hand rejuvenation, breast augmentation, and musculoskeletal regeneration were reviewed.

CONCLUSION

PRP treatment has shown itself as a bright future for a safe and efficient cosmetic intervention. However, more studies are needed to better our understanding of limitations and benefits in clinical phases associated with the aesthetic use of PRP.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Efficacy of Platelet-Rich Plasma in the Field of Hair Restoration and Facial Aesthetics—A Systematic Review and Meta-analysis

As a promising alternative to traditional treatment, platelet-rich plasma (PRP) is being used to encourage hair growth through the release of growth factors and cytokines. In addition to hair restoration, PRP’s multifactorial capabilities can also be used to treat aging skin, facial scarring, and acne. The purpose of this review is to critically examine the success of PRP in the field of dermatology, with specific attention to the role of PRP in hair restoration. Where possible, meta-analyses were used to evaluate the efficacy of PRP. In androgenetic alopecia (AGA) patients, 3 monthly PRP injections (1 session administered every month for 3 months) exhibited greater efficacy over placebo as measured by change in total hair density (hair/cm2) over the treatment period (mean difference: 25.61, 95% CI: 4.45 to 46.77; P = .02). The studies included in the meta-analysis used a half-head design, which may have influenced the results because of the effects PRP can induce. Controlled studies suggest that 2 to 4 sessions of PRP combined with traditional therapies and procedures can help minimize acne scarring and facial burns, improve aesthetic results, and decrease recovery time. However, data for these indications are lacking and are less robust in design. In conclusion, to achieve an improvement in hair restoration in patients with mild AGA, 3 initial monthly PRP injections should be given. Only upon completion of rigorous, randomized, controlled studies can standardized and effective PRP protocols for treating dermatology conditions such as acne scarring, facial burns, and aging skin be determined.