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Efficacy and safety of plasma gel versus platelet-rich plasma in periorbital rejuvenation: a comparative split-face clinical and Antera 3D camera study

  • Helwan University faculty of Medicine
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Abstract and Figures

Background Periorbital skin is the thinnest. That is why, it is the easiest to wrinkle and the most challenging to rejuvenate. Platelet-rich plasma (PRP) as well as plasma gel have been used for skin rejuvenation and considered relatively safe and effective. Methods This split-face study was conducted on forty female patients seeking periorbital rejuvenation where PRP was injected in the right (Rt) side and plasma gel in the left (Lt) side, two treatment sessions 4 weeks apart (week 0 and week 4). Patients were followed up 2 weeks after each treatment session (week 2 and week 6) as well as 12 weeks after the last session (week 16) using both subjective [physician assessment through Global Aesthetic Improvement score (GAIS) and patient’s satisfaction (Likert scale)] and objective [Antera 3D camera] assessment methods. Results Both modalities yielded a significant improvement of periorbital wrinkles after the 2nd session, with significantly better results on the plasma gel injected side; however, the improvement achieved through both modalities could not be maintained for the following 3 months. Besides, objective assessment could not prove any improvement in periorbital hyperpigmentation. Conclusion Two sessions of both PRP and plasma gel are effective for periorbital rejuvenation, with plasma gel showing significantly better results. However, improvement was not maintained for 3 months.
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Archives of Dermatological Research (2022) 314:661–671
Efficacy andsafety ofplasma gel versusplatelet‑rich plasma
inperiorbital rejuvenation: acomparative split‑face clinical andAntera
3D camera study
HebaM.Diab1· RaniaElhosseiny1· NermeenIbrahimBedair2 · AhmadHamidKhorkhed2
Received: 2 April 2021 / Revised: 11 June 2021 / Accepted: 30 June 2021 / Published online: 6 July 2021
© Springer-Verlag GmbH Germany, part of Springer Nature 2021
Background Periorbital skin is the thinnest. That is why, it is the easiest to wrinkle and the most challenging to rejuvenate.
Platelet-rich plasma (PRP) as well as plasma gel have been used for skin rejuvenation and considered relatively safe and
Methods This split-face study was conducted on forty female patients seeking periorbital rejuvenation where PRP was
injected in the right (Rt) side and plasma gel in the left (Lt) side, two treatment sessions 4weeks apart (week 0 and week
4). Patients were followed up 2weeks after each treatment session (week 2 and week 6) as well as 12weeks after the last
session (week 16) using both subjective [physician assessment through Global Aesthetic Improvement score (GAIS) and
patient’s satisfaction (Likert scale)] and objective [Antera 3D camera] assessment methods.
Results Both modalities yielded a significant improvement of periorbital wrinkles after the 2nd session, with significantly
better results on the plasma gel injected side; however, the improvement achieved through both modalities could not be
maintained for the following 3months. Besides, objective assessment could not prove any improvement in periorbital
Conclusion Two sessions of both PRP and plasma gel are effective for periorbital rejuvenation, with plasma gel showing
significantly better results. However, improvement was not maintained for 3months.
Keywords Platelet-rich plasma· Periorbital· Wrinkles· Pigmentation· Plasma gel
Being the thinnest skin of the body, mainly because of its
diminished dermis, the eyelid skin is almost transparent
and easily wrinkles [1, 2] The periorbital facial subunit
consists of the eyebrows, upper and lower eyelids, glabellar
region, and pericanthal area. It is one of the first regions to
reveal signs of aging and plays an important role in overall
facial appearance. The aging process is ruled by genetic as
well as environmental factors. Aging skin manifests by the
appearance of coarse and fine rhytides (wrinkles), uneven
texture, dryness, and mottled pigmentation [3, 4]
Hyperpigmentation of the periorbital area can be divided
into primary (idiopathic) that occurs in individuals with
otherwise healthy skin, and secondary types [5]. Second-
ary type may be caused by many etiologic factors such as
familial or ethnic tendency, periorbital edema, and post-
inflammatory hyperpigmentation, caused by atopic or aller-
gic contact dermatitis, medications, and systemic diseases.
Other factors that can be included are fatigue, smoking,
excessive sun exposure, superficial location of vasculature
of the eyelids, tear trough depression, and shadowing due to
laxity of the skin [6, 7]
Platelet-Rich Plasma (PRP), an autologous source of
platelet-derived growth factors, could play a role in skin
rejuvenation. Several hypotheses were suggested for mecha-
nisms of rejuvenation by PRP such as increased prolifera-
tion of human dermal fibroblasts, increased expression of
Matrix Metalloproteinase (MMP-1 and MMP-3), increased
* Nermeen Ibrahim Bedair
1 Department ofDermatology, Veneriology andAndrology,
Faculty ofMedicine, Ain Shams University, Cairo, Egypt
2 Department ofDermatology, Veneriology, Andrology,
Sexual Medicine andSTDs, Faculty ofMedicine, Helwan
University, Cairo, Egypt
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The treatment of sexual potential improvement is the fastest-growing and newest branch in the current medical profession. The treatment of sexual potential improvement includes various treatments and operations aimed at changing the aesthetic and functional aspects of male and female genitalia. With the rapid growth of the demand for sexual potential improvement, plastic surgery will also involve the treatment of sexual potential improvement. As a general term, genital plastic surgery, beauty, rejuvenation, and other terms have been widely used in medical literature. The treatment of sexual potential improvement is not only the plastic surgery of male and female sexual organs but also various treatment methods to improve sexual function for the purpose of treating sexual life disorder: no sexual desire, no arousal of sexual desire, no orgasm, sexual intercourse pain, etc.
Introduction: Tissue engineering is a revolutionized biotechnology that utilizes biomaterials in regenerative medicine. Nowadays, there is a trend in employing autologous-based materials in aesthetic medicine. In this review, we discuss safety and efficacy of autologous-based fillers in the fields of aesthetic dermatology, and describe the details of preparation and injection methods based on current literature. Evidence acqusition: PubMed, Scopus, Web of science, Embase and Google scholar were searched for studies which evaluated efficacy of autologous-based filler in the field of aesthetic dermatology from January 2000 until August 2022. Nineteen articles including five randomized clinical trials, ten prospective and four retrospective studies were selected for this review. Evidence synthesis: Most of the studies evaluated use of biofillers in rejuvenation (twelve articles) and the remaining were in atrophic scars (six articles) and striae distensae (one article). Adjuvant treatments included liquid platelet rich growth factor (PRGF), autologous cultured fibroblast, adipose tissue micrograft, microneedling, fractional carbon dioxide laser and subcision. Application of biofillers is a safe alternative therapeutic option for soft tissue augmentation. Conclusions: Application of biofillers is especially recommended in patients who seek low-cost rejuvenation methods and those with a past history of granulomatous reactions to the other fillers. It provides the advantage of immediate filling effects with long-lasting efficacy.
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Background: 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. Methodology: MEDLINE (PubMed) was searched from inception through 2021 for English language publications on APCs for facial rejuvenation. Results: A total of 100 files were found. Based on the available literature, APCs for skin rejuvenation are safe and well tolerated. The most studied product is the first-generation material, platelet-rich plasma (PRP). Conclusions: The results are in general favorable, but the quality of the studies is low. The second and third generation products, platelet-rich fibrin (PRF) and injectable platelet-rich fibrin (i-PRF), respectively, are easier to be obtained and, at least in vitro , seem to induce greater collagen production than PRP, especially under lower relative centrifugation forces, but to date only a few clinical trials evaluating these products exist. More high-quality trials with appropriate follow-up are necessary to provide adequate evidence that may help to improve the treatment regimens with APCs. Many aspects should be considered when designing clinical trials to evaluate APCs, such as the patients' characteristics that best predict a favorable response, the optimal number of sessions and the interval between them, the characteristics of the studies and the development of better instruments to evaluate skin aging.
Post‐inflammatory hyperpigmentation (PIH) is a common cosmetic complaint affecting patient quality of life. PIH has been proven to disproportionately affect skin of color. While several treatment options exist, special consideration must be given when managing PIH in patients of color, as topical treatments and aesthetic procedures, such as chemical peels and lasers, may either exacerbate or prove ineffective against PIH.
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Injection of platelet concentrates for the treatment of aging skin has gained popularity. The objective was to systematically assess the evidence regarding the safety and effectiveness of platelet-rich plasma (PRP) for reducing the visible signs of aging. Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus were searched from inception to March 2019 for prospective trials and case series assessing PRP for skin aging in 10 or more patients. Twenty-four studies, including 8 randomized controlled trials (RCTs), representing 480 total patients receiving PRP, were included. Based on physician global assessment, injection PRP monotherapy was shown to at least temporarily induce modest improvement in facial skin appearance, texture, and lines. Periorbital fine lines and pigmentation may also benefit. Adjuvant PRP accelerated healing after fractional laser resurfacing. Although the degree of improvement was typically less than 50%, patients generally reported high satisfaction. It was limited by heterogeneity in PRP preparation and administration, and lack of standardization in outcome measures. PRP injections are safe and may be modestly beneficial for aging skin. The evidence is most convincing for improvement of facial skin texture. The persistence of these effects is not known. More high-quality trials with sufficient follow-up are needed to optimize treatment regimens.
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Objectives Platelet-rich fibrin (PRF) has gained tremendous momentum in recent years as a natural autologous growth factor derived from blood capable of stimulating tissue regeneration. Owing to its widespread use, many companies have commercialized various centrifugation devices with various proposed protocols. The aim of the present study was to compare 3 different commercially available centrifuges at both high and low g-force protocols. Materials and methods PRF was produced on three commercially available centrifuges including the IntraSpin Device (IntraLock), the Duo Quattro (Process for PRF), and Salvin (Salvin Dental). Two separate protocols were tested on each machine including the original leukocyte and platelet-rich fibrin (L-PRF) protocol (~ 700 RCF max (~ 400 RCF clot) for 12 min) as well as the advanced platelet-rich fibrin (A-PRF+) protocol (~ 200 g RCF max (~ 130 g RCF clot) for 8 min). Each of the tested groups was compared for cell numbers, growth factor release, scanning electron microscopy (SEM) for morphological differences, and clot size (both weight and length/width). Results The present study found that PRF clots produced utilizing the low-speed centrifugation speeds (~ 200 g for 8 min) produce clots that (1) contained a higher concentration of evenly distributed platelets, (2) secreted higher concentrations of growth factors over a 10 day period, and (3) were smaller in size. This was irrespective of the centrifugation device utilized and consistently observed on all 3 devices. The greatest impact was found between the protocols utilized (up to a 200%). Interestingly, it was further revealed that the centrifugation tubes used had a much greater impact on the final size outcome of PRF clots when compared to centrifugation devices. It was found that, in general, the Process for PRF tubes produced significantly greater-sized clots when compared to other commercially available tubes. The Salvin Dental tubes also produced significantly greater PRF clots when compared to the IntraLock tubes on each of the tested centrifugation devices. Conclusions The present study demonstrated the reproducibility of a scientific concept (reduction in RCF produces PRF clots with more evenly distributed cells and growth factors) utilizing different devices. Furthermore, (and until now overlooked), it was revealed for the first time that the centrifugation tubes are central to the quality production of PRF. Future research investigating tube characteristics thus becomes critically important for the future optimization of PRF. Clinical relevance This is the first study to reveal the marked impact of centrifugation tubes on the final production of PRF. Future study thus becomes markedly important to further optimize the quality of PRF-based matrices. It was further found that little variability existed between the centrifugation devices if optimized centrifugation protocols (lower centrifugation speeds) were utilized.
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The healing of vascularized mammalian tissue injuries initiate with hemostasis and clotting as part of biological defense system leading to the formation of a fibrin clot in which activated platelets are trapped to quickly stop bleeding and destroy microbials. In order to harness the therapeutic potential of biomolecules secreted by platelets and stemmed from plasma, blood deconstruction has allowed to yield autologous platelet-and plasma-derived protein fibrin scaffold. The autologous growth factors and microparticles stemmed from platelets and plasma, interact with fibrin, extracellular matrix, and tissue cells in a combinatorial, synergistic, and multidirectional way on mechanisms governing tissue repair. This interplay will induce a wide range of cell specifications during inflammation and repair process including but not limited to fibrogenesis, angiogenesis, and immunomodulation. As biology-as-a-drug approach, autologous platelet-and plasma-derived protein fibrin scaffold is emerging as a safe and efficacious natural human-engineered growth factor delivery system to repair musculoskeletal tissues, and skin and corneal ulcers and burns. In doing so, it acts as therapeutic agent not perfect but close to biological precision. However, this autologous, biocompatible, biodegradable, and long in vivo lasting strategy faces several challenges, including its non-conventional single dose-response effect, the lack of standardization in its preparation and application, and the patient´s biological features. In this review, we give an account of the main events of tissue repair. Then, we describe the procedure to prepare autologous platelet-and plasma-derived protein fibrin scaffolds, and the rationale behind these biomaterials, and finally, we highlight the significance of strategic accuracy in their application.
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The aim of the present study was to investigate the efficacy of human umbilical cord‑derived mesenchymal stem cell (HUMSCs) embedded in platelet poor plasma (PPP) gel combined with amnion (PPPA) in improving wound healing on Sprague‑Dawley (SD) rats. HUMSCs were cultured and labeled with chloromethylbenzamido‑1,1'‑dioctadecyl‑3,3,3'3'‑tetramethylindocarbocyanine perchlorate (CM‑DiI) on their third passage. The expression levels of growth factors of HUMSCs in PPPA were assessed by ELISA. Full‑thickness excisional skin wounds were induced in 36 male SD rats, which were treated with PPPA grafted with HUMSCs (PPPAC), PPPA, or HUMSC or PBS injection. The degree of healing and the distribution of labeled HUMSCs in the wound were evaluated by hematoxylin and eosin (H&E) staining and immunofluorescence. On day 14 post‑surgery, wound healing in PPPAC‑treated rats was significantly higher than the PPPA group, compared with rats treated with HUMSCs alone and control rats (P<0.05 and P<0.01, respectively). H&E staining showed that morphology and thickness of the epidermis in the PPPAC group was similar to that of healthy skin. ELISA revealed that levels of growth factors of HUMSCs in PPPAC were higher than in monolayer cells. In conclusion, PPPA can modify growth factor expression levels of HUMSCs and improve the efficiency of HUMSCs in the healing of full thickness wounds in rats.
Background: NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. Objective: To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. Methods: The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. Results: There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. Conclusion: Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.
Background The popularity of dermal fillers has grown rapidly in the last few years for facial rejuvenation. Plasma gel is an autologous gelatinous material that is prepared from the patient's own platelet poor plasma. Objective To evaluate the clinical efficacy and safety of plasma gel injection as a dermal filler for facial rejuvenation. Patients and Methods The current study was carried out on 52 females presented with facial aging divided into two groups: Group A included 34 females with facial wrinkles, and Group B included 18 females with tear trough deformity. After taking written informed consent, they received two sessions of plasma gel injections at 2‐week interval and followed up monthly for 3 months. They were assessed clinically before treatment sessions and at the end of follow‐up period. Results Both studied groups showed immediate significant clinical improvement after plasma gel injection that maintained till the end of follow‐up period. This finding was confirmed by significant reduction in the mean values of Wrinkle Severity Rating Scale (WSRS) in Group A and Tear Trough Rating Scale (TTRS) in group B, and significant improvement of skin homogeneity and texture in both groups. In general, the reported side effects were minimal and transient. Conclusion Autologous platelet poor plasma gel injection seems to be a cost‐effective, safe, well‐tolerated, and minimally invasive technique producing significant aesthetic correction of facial wrinkles and tear trough deformity.
Background The demand for safe and minimally invasive soft tissue augmentation procedures has increased. Recently, a novel injectable gel based on the autologous platelet rich in growth factor (PRGF) technology has been developed to provide long‐term shape and volume stability. It can be customized into low (LVG) or high viscosity (HVG) gel forms to meet different dermatological requirements. Objectives The mechanical and biological properties of both gel forms have been evaluated. The clinical efficacy and safety of this autologous procedure were also evaluated. Methods Growth factor content and biomechanical properties of both gel forms were determined. The in vitro biological capacity on human dermal fibroblasts proliferation was assessed. Clinical performance analysis over ten patients was evaluated by standardized macrophotographs, 3D topographic images, and ultrasound analysis over periocular and nasolabial areas. Results Both gel types showed similar growth factor concentration. HVG showed a higher stiffness profile indicating its suitability for deeper tissue defect viscosupplementation while LVG showed optimal rheologic characteristics for superficial volumization. Both gels showed a noticeable biostability after catalytic enzyme degradation. Both forms significantly increased the mitogenic activity of dermal fibroblasts. All patients referred to be highly satisfied and presented optimal clinical results after one month. Overall clinical improvement was maintained for 16 weeks. At the end of the study, the ultrasound examination revealed a cutaneous regenerative effect. No adverse events occurred. Conclusions This preliminary study suggests that autologous platelet gels have desirable mechanical and bioactive properties and allows moderate wrinkle reduction and efficient facial volume reposition with natural results.
Proper diagnosis and management of eyelid disorders, both functional and cosmetic, hinge upon a thorough understanding of the location of critical eyelid structures and the anatomic relationships between them.
Background: The skin imaging analysis instruments are widely used to record and measure the surface and subsurface skin conditions. The main aim of this study is to reveal the differences and correlations in measuring wrinkle, skin texture, coloration/evenness, vascular features, and pore between two commercially available instruments. Methods: Twenty-eight subjects were enrolled in the study. A 2*2 cm cardboard was used to make sure the two instruments analyze the same area. Pictures were taken and analyzed by the VISIA(®) from Canfield and the ANTERA 3D(®) CS from Miravex, in sequence. Results: The spot, ultraviolet spot, brown spot, red area, texture values measured with VISIA(®) were positively correlated with age, while the pore and wrinkle values showed no significance. The wrinkle, texture, melanin, hemoglobin, pore index, pore volume values measured with ANTERA 3D(®) had a significantly positive correlation with age. The spot, brown spot values from VISIA(®) were positively correlated with the melanin value from ANTERA 3D(®) . Texture value measured with the two instruments revealed positive linear correlation. Strong correlation was found between the red area value from VISIA(®) and the hemoglobin value from ANTERA 3D(®) . Ultraviolet spot from VISIA(®) showed no linear correlation with the melanin value from ANTERA 3D(®) . Neither of the wrinkle and pore measured with the two instruments showed linear correlation. Conclusions: ANTERA 3D(®) relies on multidirectional illumination obtained by LEDs of different wavelengths from different directions which make it advanced at the qualitative evaluation of various dermatologic conditions. Compared with VISIA(®) , ANTERA 3D(®) is more sensitive in the assessment of wrinkle and it may also be available to evaluate the aging-related enlarged pore.