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Using objective criteria to evaluate cosmetic effects of platelet rich plasma
Abstract
Gilbert Amgar, Christian Bonnet, Alain Butnaru and Fabienne Herault-Bardin discuss the results of a study which aimed to evaluate the efficacy of platelet rich plasma as a facial skin treatment
Autologous platelet rich plasma (PRP) plays an important role in soft tissue healing. The purpose of this study was to evaluate the efficacy of this facial skin treatment through objective parameters. Biometric parameters, including anisotropy, transepidermal water loss (TEWL), micro-relief, and hydration were used to determine the relative success of the treatment. The study, which included 37 female patients, demonstrated an average of 24% improvement in the anisotropy coefficient after the third week. The TEWL and micro.relief parameters also improved significantly (P < 0.05 in all parameters tested). In addition to these results, this study suggests that certain measured values may be used to predict the success of the aesthetic use of PRP.
... The study design, age range of participants, number of injection sessions, duration of follow-up, technique of PRP application, and assessment methods were extracted from each study and compared. In the selected articles, a study by Amgar et al. 15 evaluated the effect of PRP without any activation prior to injection and a study by Shin et al. 13 used PRP gel. The other eight studies used CaCl 2 for PRP activation. ...
... Both genders were included; however, females were the dominant group. Only one study conducted by Amger et al. 15 mentioned that improvement in the skin rejuvenation was age dependent and suggested the frequency as well as the intervals of PRP injection in each age group. It can be postulated that the age dependent results of PRP therapy might be associated with tissue repair mechanisms which are anticipated to work better in younger age groups. ...
... Some animal studies have shown a decrease in the expression of growth factor receptors due to aging. More specifically, a significant decrease has been observed in the expression of TGF-beta 15 Volume of blood not mentioned. Single centrifugation, no activation of PRP ...
Background: With the increase in life expectancy, middle aged and elderly people comprise a substantial percentage of the population worldwide. Since aging often manifests itself in the human skin, skin rejuvenation methods have gained a lot of popularity. Current medical modalities such as botulinum toxin injection, fillers, and laser therapy can provide symptomatic relief of skin aging signs without the ability to induce changes at a cellular level. In recent years, Platelet Rich Plasma (PRP) therapy has been emerging as a revolutionary treatment with the ability to induce cell growth in the skin, which results in retarding and reversing the aging process. Therefore, this study was conducted to determine the efficacy of PRP therapy in skin rejuvenation. Methods: A comprehensive search was conducted using PubMed, Google Scholar, and Cochrane library. Articles published only in English from 2000 to 2015 were included. The keywords used were platelet rich plasma, PRP, skin rejuvenation, skin aging, skin, platelet rich plasma therapy. Results: A total of ten articles were retrieved and included for analysis. Eight studies showed improvement of the skin wrinkles. The other two studies reported improvements in the nasolabial fold. Clinical assessments were based on patient satisfaction or feedback questionnaire, pre- and post-treatment photography, and skin biopsy. The results showed a significant improvement in the skin appearance, elasticity, texture, and homogeneity. Conclusion: In conclusion, PRP therapy is an effective and safe treatment for skin rejuvenation with no significant difference in varying techniques of PRP preparation and injection.
... Multiple plasma proteins and activated platelet membranes work together to generate a clot (4) . For many years, the idea of using a patient's blood or components to assist the healing process has been widely used (5) . ...
... The second spin (called the soft spin) further separates the platelets, white blood cells and few remaining red blood cells from the plasma (Mehryan et al, 2014). Regarding facial rejuvenation, some researchers use single centrifugation (Sclafani, 2011;Amgar et al, 2011;Redallei et al, 2010;Zenker, 2010), while others use double centrifugation in their studies (Mikhaeland El-Esawy, 2014;Shin et al, 2012). However, all preparation methods of PRP result in significant increase in platelet count compared to native blood. ...
The purpose of this study was to compare the clinical effectiveness and safety of PRP injections using either single-spin or two-spin preparation method. Fourty patients (all are females with ages between 21-56 years old) were included in this study. The patients are divided into two groups, the first group 20 patient were injected by PRP which was prepared by single centrifuge at 3000 rpm for 10 minute. The second group: 20 patientswere injected by PRP which was prepared by two centrifuge method where the first centrifuge was done at 3000 rpm for 10 minute for isolation of plasma then the plasma was condensed by second centrifuge at 3000 rpm for 10 minute then the PRP injected alone without platelet poor plasma (PPP). By using objective clinical assessment and subjective satisfaction scale revealed : In first group, 4 patient showed improvement with the score of 4.1-5 (80-100%), 6 patients with the score of 3.1-4 (60-80%), 6 patients with the score of 2.1-3 (40-60%) and 4patients with the score of 1.1-2 (20-40%) at the end of study.In second group, 3 patient showed improvement with the score of 4.1-5 (80-100%), 8 patients with the score of 3.1-4 (60-80%), 7 patients with the score of 2.1-3 (40-60%) and 2 patients with the score of 1.1-2 (20-40%). There are controversies regarding the optimal method of PRP preparation that produce the best clinical effectiveness. Within the limit of this study, the one-spin procedures produce comparable results with two-spin procedure for safe therapeutic application.
Background: Despite the progress achieved in the last decade, wound healing remains a difficult issue to which modern medicine does not always have an efficient response. Currently, it has been well established that platelets play a fundamental role in wound healing, primarily through the formation of platelet clots and the release of many growth factors and cytokines. Design: Prospective randomized trial Methods: I) The platelet concentrate collected from 10 volunteers using the RegenKit® filter system (Regen Lab, Switzerland) was, at first, qualitatively evaluated in vitro. II) The impact of platelet concentrate on skin graft donor sites healing. Three groups of 15 patients were treated between June 2005 and March 2006 at CHUV, Lausanne, Switzerland. After randomization, patients were treated either with a standard dressing or using platelet concentrate with or without a suspension of keratinocytes. Wound healing was compared across the 3 groups, looking at the duration and quality of the healing process as well as the resulting pain. Results: I) Blood centrifugation using the RegenKit® system (Regen Lab, Switzerland) yielded - four times the concentration of platelets compared to normal blood concentration. - stability over time and neutrality with regards to coagulation parameters. II) Reduction of healing time from 12 days for the control group to 7 days for the APG group (Autologous platelet gel) and down to 5 days for the APG+K (Kératinocytes) group with significant decrease of resulting pain. Conclusion: The results of this study confirm our speculations on the major role of the enriched platelet clot in stimulating wound healing. This also supports the possibility of using this concentrate to carry a suspension of autologous keratinocytes. This latter combination proves to be the most effective way to enhance wound healing.
Platelet-rich plasma (PRP) has shown to be a general stimulation for repair. Purpose To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis.
Randomized controlled trial; Level of evidence, 1.
The trial was conducted in 2 teaching hospitals in the Netherlands. One hundred patients with chronic lateral epicondylitis were randomly assigned in the PRP group (n = 51) or the corticosteroid group (n = 49). A central computer system carried out randomization and allocation to the trial group. Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering technique. The primary analysis included visual analog scores and DASH Outcome Measure scores (DASH: Disabilities of the Arm, Shoulder, and Hand).
Successful treatment was defined as more than a 25% reduction in visual analog score or DASH score without a reintervention after 1 year. The results showed that, according to the visual analog scores, 24 of the 49 patients (49%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was significantly different (P <.001). Furthermore, according to the DASH scores, 25 of the 49 patients (51%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was also significantly different (P = .005). The corticosteroid group was better initially and then declined, whereas the PRP group progressively improved.
Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection. Future decisions for application of the PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.
A platelet-fibrinogen-thrombin mixture utilizing autologous platelets was studied for its potential as a corneal adhesive. In the rabbit it demonstrated sufficient adhesive properties to allow 50 per cent of lamellar keratoplasties (autotransplants) to remain in place without the use of sutures. The mixture retains significant adhesive properties for four to six days. It is simple to prepare and apply. It also appears nonantigenic and nontoxic to the cornea; it does not incite inflammation, nor interfere with corneal clarity or the regrowth of corneal epithelium.
To compare the efficacy and safety of topically applied recombinant human platelet-derived growth factor-BB (rhPDGF-BB) (becaplermin) with placebo gel in patients with chronic diabetic neuropathic ulcers of the lower extremities.
This multicenter double-blind placebo-controlled phase III trial included 382 patients with type 1 or type 2 diabetes and chronic ulcers of at least 8 weeks' duration. After sharp debridement of the ulcer, patients were randomized to receive becaplermin gel 30 micrograms/g, becaplermin gel 100 micrograms/g, or placebo gel, in conjunction with a standardized regimen of good wound care until complete wound closure was achieved or for a maximum of 20 weeks. Moist saline-soaked gauze dressings were changed twice daily with study medication applied by patients or caregivers at the evening dressing change. Safety was assessed by monitoring adverse events (AEs) and by clinical laboratory evaluations.
Compared with placebo gel, becaplermin gel 100 micrograms/g significantly increased the incidence of complete wound closure by 43% (50 vs. 35%, P = 0.007) and decreased the time to achieve complete wound closure by 32% (86 vs. 127 days; estimated 35th percentile, P = 0.013). AEs reported during treatment or during a 3-month follow-up period were similar in nature and incidence across all treatment groups.
Becaplermin gel 100 micrograms/g, in conjunction with good wound care, significantly increased the incidence of complete wound closure and significantly reduced the time to complete closure of chronic diabetic neuropathic ulcers. The safety profile of becaplermin gel was similar to that of placebo gel.
Background PubMed accessed on January 23 revealed 160 items about ‘platelet gel or releasate’ associated to topical therapy. Yahoo! provided 8580 items; Altavista 8650; Google 25 300. Companies providing blood separators are going to offer devices to prepare platelet-rich plasma (PRP) for topical therapy. Several devices are filling the marketplace aiming to produce platelet gels for human therapy. Never-ending lists of clinical conditions supposed to benefit from platelet gel application are published. Clinical benefits include bactericidal activity, pain reduction, tissue repair and regeneration. Are platelet derivatives the magic bullet for topical therapy?
A special local burn wound treatment, using a healing promotion factor, attempted to achieve earlier wound closure. Clinically it is not difficult to harvest autologous human platelet-derived wound healing factor (HPDWHF) from burn patients. Another study has proved that porcine pituitary extract (PPE) could be one of the supplements for growing human keratinocytes in vitro (Wang HJ, Chen TM, Tung YM et al. Burns 1995). Initially, using the ELISA immunoassay, we detected titres of platelet-derived growth factor heterodimer AB (PDGF-AB) and epidermal growth factor (EGF) in HPDWHF and PPE. After elevating a 6 X 9 cm2 flap on the backs of Sprague-Dawley (SD) rats 1 ml of heterologous HPDWHF and PPE were sprayed topically on the wound and followed by grafting six pieces of 1 cm2 autologous full-thickness skin. The flap wound was then closed with a piece of large-pore Biobrane interposed between the skin graft wound and the flap. On postgraft day 7, the wound was reopened to measure the area of the full-thickness skin graft (FTSG) using micrographic paper; the results are reported as the percentage of graft expansion beyond the original size. In the cytokine study, we found that the concentrations of PDGF-AB dimer in HPDWHF and PPE were 5222 +/- 102 and 375 +/- 12 pg/ml (both values are reported after a 1:10 dilution) (n = 3), whereas the EGF concentration was 245 +/- 9 pg/ml, and undetectable in undiluted PPE (n = 3), thereby proving that the PDGF-AB and EGF fibres in the HPDWHF were significantly higher than in the PPE Both the HPDWHF (n = 6, with each animal grafted with six skin graft samples) and PPE (n = 7) demonstrated significant accelerations of FTSG growth, with 14.41 +/- 1.08 per cent and 13.16 +/- 3.25 per cent increases in the FTSG size when compared to the sham control group 1.39 +/- 3.26 per cent (n = 5) (P < 0.05). Comparisons between the treatment groups showed no evidence to indicate that the HPDWHF is superior to the PPE in accelerating FTSG growth (P > 0.05). This supports the hypothesis that PDGF appears to transduce its signal through wound macrophages and may trigger the induction of positive autocrine feedback loops and synthesis of endogenous wound PDGF and other growth factors, thereby enhancing the cascade of tissue repair (Pierce GF, Mustoe TA, Altrock B et al. 1991; J Cell Biochem 1991; 45: 319-326), and the effect that PDGF-AB on wound healing is not dose dependent (Mustoe TA, Cutler NR, Allman RM et al. Arch Surg 1994; 129: 213-219). In future studies we expect to show that autologous HPDWHF and heterologous PPE will promote skin graft wound healing in burn patients since they contain a high concentration of PDGF-AB.
Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).
This study was performed to assess the safety and efficacy of treatment of iatrogenic pseudoaneurysms with fibrin adhesive. 28 patients with iatrogenic pseudoaneurysms were treated. The first 20 patients had either at least one previously unsuccessful treatment of ultrasound guided compression repair (UGCR), a contraindication to UGCR or could not tolerate the procedure. Diagnosis was confirmed on ultrasound and angiography and a balloon inflated across the neck of the pseudoaneurysm. Fibrin adhesive was injected under ultrasound control directly into the pseudoaneurysm sac. The balloon was deflated after 15 min and check ultrasound and angiography performed, with a further ultrasound at 24 h. The subsequent eight patients underwent embolisation as the first line treatment without use of a protective balloon. 16 of the first 20 patients (80%) and all of the subsequent 8 patients had successful embolisation of the pseudoaneurysm after a single treatment. Two pseudoaneurysms failed to thrombose despite two treatments in one case and three treatments in the other, and both required surgery. The only significant complication was the development of local cellulitis in one patient. In conclusion, embolisation of iatrogenic aneurysms with fibrin adhesive is a safe and effective treatment. It should be considered as an alternative to surgery and UGCR.
The response of living tissue to injury is a central component in the planning of all surgical procedures. The wound-healing process is typically divided into three phases (inflammatory, proliferative, and remodeling) and is a complex process in which a multitude of cellular and humoral components interact to restore a wound defect. Platelets and their released cytokines and growth factors are pivotal in the modulation of this entire process. Although several techniques may be used to achieve hemostasis after initial injury, few initiate and actually accelerate tissue regeneration. Both platelet gel and fibrin glue are effective hemostatic agents. Platelet gels, unlike fibrin glue, have a high concentration of platelets that release the bioactive proteins and growth factors necessary to initiate and accelerate tissue repair and regeneration. In particular, two growth factors that play a major role in platelet gels are platelet-derived growth factor, a powerful chemoattractant, and transforming growth factor beta, which significantly increases and stimulates the deposition of extracellular matrix. In creating a platelet gel, autologous blood is centrifuged to produce a concentrate high in both platelets and plasma. This concentrate can be applied to wounds, providing hemostasis, adhesion, and enhanced wound healing. Recent techniques for the autologous concentrating process have been streamlined, and now platelet gels are clinically accessible to most physicians. Platelet gels have global applications in surgery and are especially useful for the soft tissue and bony reconstructions encountered in facial plastic and reconstructive surgery. In these applications, their use has been associated with a decrease in operative time, necessity for drains and pressure dressings, and incidence of complications. When applied to bony reconstruction it provides adhesion for the consolidation of cancellous bone and comminuted fracture segments.
Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention.
Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem.
Cohort study; Level of evidence, 2.
One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5).
Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P =.001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores (P =.0001). At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P <.0001).
Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.
The purpose of this work was to develop a new sensor for objective in vivo measurement of the cutaneous temperature based on micro-electro-mechanical systems (MEMS), and to compare these performances with those of a classical thermocouple. Research on this new sensor was carried out to allow the quantification of the thermal properties of the made-up skin.
Sixteen female subjects divided into two different age groups (18-35 and >50 years old) were recruited for this study. Several zones of the face and forearms were made up at random with foundations containing or not a thermoregulator raw material. The quantity of foundation applied on the skin was standardized and measurements were carried out first before make-up, and then 10 s and 5 min after make-up. The new sensor and the thermocouple were used successively on each zone. The cutaneous temperature was expressed in degrees celsius.
The two systems are similar in terms of repeatability and reproducibility, with some differences in sensibility. The data measured by the MEMS sensor appear lower than those measured by the thermocouple. After make-up, the MEMS sensor detects a progressive increase of the temperature in time whereas the thermocouple detects a decrease. We found the same evolution on the face but in a more attenuated way. These results tend to show that the devices do not measure the same phenomenon. The thermocouple appears more sensitive to the thermal response of the made-up surface whereas the MEMS sensor appears more sensitive to the heat transfers in the interface between the skin and make-up.
The aim of the present study was to determine the attendant effects of physical (tape-stripping) and chemical (three commercial hydrating formulations) treatments upon biophysical and micro-relief properties of human skin. In the first set of experiment, the effects of tape-stripping onto human stratum corneum (SC) biophysical and micro-relief properties were assessed in nine volunteers. Transepidermal water loss (TEWL), skin hydration and micro-relief parameters (including total length of the lines in mm per mm(2); total surface in %; roughness of the skin measured in gray level (Ra); maximum profile valley (Rv) depth; maximum profile peak height (Rp); maximum height (Rt), peak density (Pc) and coefficient of anisotropy) were determined by using SkinEvidence Pro after subsequent tape-stripping of SC. The relevance of roughness determination as gray level by SkinEvidence Pro was confirmed by using surface roughness standards. In the second set of experiment, the effectiveness of three commercial hydrating formulations onto human SC biophysical parameters and micro-relief properties were assessed in six volunteers. TEWL, hydration and micro-relief parameters were assessed onto pre-treated acetone skin and then treated by three commercial hydrating formulations after 2, 4 and 6 h skin exposure. A linear relation between hydration and cutaneous parameters (total length of the lines, Ra and Rp) as function of SC removed was shown. Skin barrier properties evaluated by TEWL measurements, were not modified by topical formulations. However, skin treated by topical formulations showed slightly higher hydration than the one determined in control group, while micro-relief parameters were not modified. In this study was showed that biophysical and micro-relief parameters were closely related in tape-stripping experiment. Efficiency of topical formulations was suggested upon skin hydration but not onto skin micro-relief and barrier function recovering. From both experiments, it appears that different mechanisms relating to skin hydration and potential modification of cutaneous micro-relief were suggested.
Self-Regenerin’: Utilisation du plasma riche en plaquette autologue dans la revitalisation du visage
- G Amgar
Clinical usage in plastic surgery of biologic glue
- Wj Welsh
Utilisation des extraits plaquettaires autologues en médecine esthétique
- G Amgar