Platelet Rich Plasma has been receiving considerable attention in the field of dermatology and medical aesthetics. The current literature is exploding with reports of its mechanism and clinical efficacy.
PRP alone or in combination with other modalities has demonstrated considerable benefit for cosmetic applications and skin diseases. Only a few transient side effects have been reported with the use of Platelet Rich Plasma and Platelet Rich Fibrin.
Platelet Rich Plasma is an autologous blood derived concentration, rich in bioactive proteins such as cytokines and growth factors.
In the preparation of PRP, anticoagulants such as acid citrate dextrose are added to the processing tube to prevent coagulation but also to prevent the premature secretion of the bioactive proteins contained on the alpha granules residing on the platelets.
Once processed, PRP is then separated from the platelet poor plasma and the remaining red blood cells. The PRP is then activated to release the contents of the alpha granules. There are many growth factors that are released. These include platelet derived growth factor, transforming growth factor, vascular endothelial growth factor, epidermal growth factor and insulin like growth factors.
Various types of growth factors bind to cell surface receptors and activate signaling pathways resulting in the synthesis of proteins that increase cell numbers and result in overall growth.
An individual’s baseline platelet count can influence the outcome, therefore a person’s platelet count must be determined and considered.
Platelet Rich Plasma is now considered a treatment choice for a variety of dermatological conditions including skin rejuvenation. This includes wrinkles, pigmentation, loose or sagging skin, coarseness and volume loss. PRP induces the remodeling of the extracellular matrix. This process increases the activation of the matrix metalloproteinases to remove photodamaged extracellular matrix components and stimulates the proliferation of dermal fibroblasts and collagen.
Matrix metalloproteinases are a group of enzymes that can break down proteins such as collagen that are normally found in the spaces between cells in tissue. These enzymes need calcium and zinc to function properly therefore called “metallo “proteinases. They can remove damaged tissue but can also be triggered and cause destruction of normal tissue in the extracellular spaces in certain instances.
The remodeling of tissue by PRP is not a function of the percentage of PRP. In a recent study, 5% PRP was reported to more strongly induce the production of procollagen than 10% PRP. Also, fibroblast proliferation was higher in the 5% PRP concentration than 10%.
In another study on human skin, punch biopsies were performed at three-time intervals and compared to saline. They were compared at baseline before injection, 2 days after PRP and 28 days after. Collagen fibers in the dermis and the thickness of elastic fibers were significantly increased in the PRP group. The authors concluded that PRP increased dermal collagen levels not only through growth factors but also via the micro needling technique used on these patients. They also concluded that PRP to be a safe and effective procedure, with benefits even after a single application for facial rejuvenation.
Objective assessments of PRP were examined for efficacy in two separate studies by Everts et al and Cameli et al. They both administered 3 regimens of PRP at one moth intervals by micro needle technique. Both studies found similar results,
- Decrease in brown spots.
- Decrease in wrinkle count.
- Decrease in redness.
- Increase in skin firmness.
- Increase in skin elasticity.
- Increase in smoothness.
The first randomized controlled clinical trial was performed in 2018 on PRP needling vs saline on the contralateral cheek. This was one injection then followed in 6 months. The six month follow up demonstrated significant improvement of the PRP side comparing skin texture and wrinkles.
In the use of PRF as a filler, nasolabial folds responded the most favorably followed by crow’s feet and transverse forehead lines. There was significant improvement in fine wrinkles, skin homogeneity and texture with notable improvement in the fourth week and the greatest improvement in the eight weeks after treatment.
After a single PRP treatment, patients were given a Face and Cheek appearance appraisal scale evaluation. The majority of patients were pleased with the result (74.2) and declared the procedure was worth the time and effort (80%).
In Indonesia, a split face, double blind study was conducted using PRP and ready-made growth factors. They were treated for skin rejuvenation every 2 weeks for a period of 3 months. One month after the last administration, there were no significant differences in the final epidermal and dermal thickness between both groups. However, at six months, the PRP group showed sustained improvement whereas the growth factor group showed a decrease in both epidermal and dermal thickness. The authors concluded that the PRP group showed sustained effects because growth factors and cytokines were naturally induced by the PRP.
Scalafani et al used platelet rich fibrin to correct deep nasolabial folds. The wrinkle score was assessed immediately after and at two, six, and twelve weeks after treatment. There was a measured continued improvement. The authors concluded that PRF could provide a long-term diminution of deep nasolabial folds without causing excessive fibrotic change to the area. PRF showed a significant greater ability to induce collagen matrix synthesis, cell proliferation, fibroblast migration and messenger RNA expression of the growth factors, TGF, collagen 1, and fibronectin relative to PRP.
The literature is full of the studies confirming PRP and PRF to be effective and safe for skin rejuvenation. The side effect profile of burning, erythema, swelling, ecchymosis is transient and typically resolves in hours to days. Overall, most authors concluded the cost, lack of significant side effects and the effectiveness of PRP and PRF make them a primary treatment modality for facial rejuvenation.
Human dermal fibroblasts, the main cell population in the dermis, gradually lose their ability to produce collagen and renew intercellular matrix with aging. As cosmetic desires increase to fight the effects of age, many solutions have been used to combat this process. These include antioxidants, peptides, retinoids, growth factors and platelet rich plasma. Autologous dermal fibroblast injections are capable of improving facial contour and create a continuous repair system. This significantly aids in the elimination of wrinkles. However, fibroblasts gradually lose their capability to proliferate and remodel with age. As dermal fibroblasts lose this ability, the rate of collagen production decreases and the degradation of the dermal matrix increases. This is driven by metalloproteinases in the skin.
Exosomes can mediate cell to cell communication and regulate the properties of the dermis. They have been shown to reduce the expression of metalloproteinases and upregulate the expression of collagen. Topical treatment with exosomes can reach the epidermis and be absorbed into the skin. However, the efficacy is dependent on penetration through the stratum layer. Micro needling can deliver exosomes through this layer and can easily deliver intact vesicles across the skin.
When used together with platelet rich plasma, exosomes can modulate the cell-to-cell communication while platelet rich plasma can induce the microenvironment for a sustained regeneration.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. This activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory environment. When used with the Juventix Regenerative Medical HA Kit, the combination provides a natural non-cross-linked hyaluronic acid filler with anti-inflammatory properties for all the applications typically performed in the aesthetic arena.
Juventix Regenerative Medical has many more products and services for the regenerative professional. Our newest collaboration is with Evolutionary Biologics who supply many regenerative products such as exosomes. Evolutionary Biologics aspires to establish homeostasis through a balanced mind, body and cell transformative lifestyle. The EVO product line helps the body to operate as initially designed and optimizes its functionality for the best quality of life.
The synergistic relationship between Juventix and Evolutionary Biologics provides quality and efficacy unsurpassed in the regenerative medical field.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Dr. Robert McGrath
- Needle Free Injection of Exosomes Derived from Human Dermal Fibroblast Spheroids Ameliorates Skin Photoaging
ACS Nano 2019 Oct 22;13(10): 11273-11282 PMID 31449388
J Cosmet Dermatol 2010 Mar;9(1): 66-71 PMID 20367676
- Effect of Platelet Rich Plasma Injection for Rejuvenation of Photoaged Facial Skin: A Randomized Clinical Trial
JAMA Dermatol 2018 Dec 1 ;154(12):1447-1452 PMID 30419125
J Clin Aesthet Dermatol 2020 Aug:13(8): 28-35 PMID 33178379