Apsaras Aesthetic Clinic | PRP Skin Rejuvenation

Dermal filling using the body’s own cells MYCELLS
(autologous platelet rich plasma)

Introduction

Softening of deep wrinkles and lines and augmentation of lips,cheeks and chin areas are currently treated mostly with non-permanent synthetic products such as hylauronic acid, calcium hydroxylapatite, poly-l-lactic acid, animal derived bovine collagen and autologous lipofilling (using fat cells from other parts of the body to be injected in the face)

A New treatment using the body’s own platelets called MYCELLS is now available. This treatment has been labeled light heartedly in the press as "Dracula Therapy"

Platelets are cells present in the blood that play a part initially in cessation of bleeding and later in the healing  of the wound caused by injury or surgery.

Platelets, when present in body tissue outside the blood stream, are activated by various chemicals to release growth factors and to release chemicals that attract stem cells to the area of injury.

The growth factors stimulate cells such as fibroblasts to produce new collagen and the stem cells can hange into epidermal cells that are normally present in the outer layer of the skin, fibroblasts in the dermis (deep layer of skin) or even pre-adipocytes which are cells with the ability to convert into fat cells, important in the face to maintain plumpness.

At the same time, production of new extra-cellular matrix ( the substance that binds cells together) and microscopic blood vessels take place.

Platelet Rich Plasma Applications

Platele rich plasma has been used with great success in clinical practice since the 1990’s. It was initially used to enhance would healing in maxillo-facial surgery (dental implants and sinus elevations) and soon after became popular in disciplines such as heart surgery, orthopaedic surgery and dermatology (chronic would healing).  The latest application of aurtologous platelet rich plasma now includes cosmetic indications as well.  This skin rejuivenation technique has been used since 2004 in countries such as Japan,United Kingdom, Spain,Portugal and Argentina to mention but a few.

Autologous Platelet Rich Plasma

The term autologous means that the source of origin is the patient’s own body and not from another human donor or from animal origin. Thus, when a patient’s own platelet rich plasma is used to treat damaged or aged skin, the term autologous platelet rich plasma (A-PRP) indicates that  the source is from himself/herself. Platelet enriched plasma contains several million more platelets resulting in more growth factor release and more stem cell attraction compared to the normal wound healing process.

How can plasma be ‘enriched’ ?

Several enrichment systems are in existence, but the majority are expensive and the process very laborious. A new way of enrichment is now possible in the practitioner’s own rooms or clinic and the whole process takes less than 30 minutes (excluding injection time). Approximately 16 ml (2 tubes of 8 ml each) of venous blood is collected from the patient’s fore-arm and placed in a centrifuge for 10 minutes. Centrifugation separates the red blood cells from the plasma and platelets. The platelets in the plasma are now enriched 2 – 5 times compared to the native concentration in blood.

Effects of platelet activation:

The platelets need to be activated prior to injection with CaCl2, because active platelets release growth factors and attract stem cells. The activated platelet rich plasma will react with fibrin present in the plasma to form a biologically active fibrin-strand ‘scaffold’ in the skin, contrary to a synthetic dermal filler that is not biologically active. The ‘scaffold’ hosts the platelets entrapped within the fibrin strands and over the next approximately 300 days new micro blood vessels (neo-vascularisation) grow into it as well as fibroblasts and stem cells. The ‘scaffold’ is gradually replaced by normal extra-cellular matrix, cells and blood vessels resulting in natural tissue rejuvenation.

Injection techniques:
The autologous platelet rich plasma is injected either as a mesotherapy technique (multiple injections very superficially into the skin) or exactly like a synthetic dermal filler into wrinkles and lines and also for lip-, cheek- and chin augmentation. As already mentioned, the duration of the rejuvenation process is approximately 300 days, but the clinical effect should last longer because of new collagen and elastin formation.

Patient selection
From approximately age 27 years, our bodies produce less collagen and elastin and especially the skin of the face looses elasticity and begins to ‘sag’. This process is complicated by our environment (UV light exposure), our lifestyle (excess alcohol and smoking) and disease.

Age 30 – 40 years: In this age category the main aim is rejuvenation and prevention of collagen degradation and re-stimulation of new collagen and elastin production, thus attempting to slow down the ageing process. One treatment every 2-3 years is sufficient.

Age 40 – 50 years: In this age category the aim is rejuvenation and to attempt reversal of the ageing process which is more difficult. More re-stimulation of collagen and elastin production is necessary. The initial treatment should be followed by a second treatment 6 months later and a third treatment 9 months after the second treatment. Follow-up ‘maintenance’ treatments may be necessary every 12-18 months.

Age 50+ years: In this age category the aim is rejuvenation and to attempt more intense reversal of the ageing process. The initial treatment should be followed by a second treatment 3-6 months later and a third treatment 6 months after the second treatment. Follow-up ‘maintenance’ treatments may be necessary every 12 months.

INDICATIONS:

This technique is aimed at treating fine wrinkles or lines as well as volumetric filling of the ‘tear trough’, eyelids, nose-to-lip lines, mouth corner lines, lips, and augmentation of lips, cheeks and chin areas. It is also indicated for acne scars.

PAIN CONTROL:

Topical anaesthetic cream 30-45 minutes pre-injections plus ice packs are most of the time sufficient in terms of analgesia. Very sensitive areas such as the lips and forehead areas may require infiltration with local anaesthesia. Ironically, the eyelids are not very sensitive although they are close to the eyes, because the skin is very thin and is effectively numbed with topical anaesthetic creams and ice. Patients are advised not to take any anti-inflammatory drugs such as ibuprofen or aspirin after the treatment, because these drugs suppress inflammation. Inflammation is one aspect responsible for platelet activation.

SIDE-EFFECTS:

Bruising is usually minor, especially when after the treatment a vitamin K containing cream is applied. Swelling is to be expected but usually settles down in 1-2 days’ time except around the eyes that can take 4-7 days to subside completely.

Risk of infection in the same as like any other dermal filler.

Pre-treatment patient preparation:

Patients are advised to start taking products that stimulate fibroblasts to produce more collagen such as vitamin C (1,000 mg daily and vitamin D (not more than recommended daily requirement) from 7-14 days before the day of treatment.

Again, vitamin A cream and vitamin C serum 7-14 days pre-treatment will also start to activate fibroblasts. Patients are advised to continue indefinitely with these topical products in any event.

Combination treatments:
Radio-Frequency (RF) stimulate fibriblasts to produce new collagen.  RF treatment can be used to enhance the effect of platelet rich plasma treatment. RF two weeks  and again four weeks after treatment is recommended.  Combination treatments are certainly of great value in the age groups 40+ years.

CONCLUSION: