Science behind Vampire Face Lift
In this anti-aging age, perhaps it’s unsurprising that vampires — ancient, but with forever-young skin — are a cultural obsession. Twilight books and films promoted the idea of living forever. Now a cosmetic treatment to fill in wrinkles or to plump up hollow cheeks is being marketed as a “vampire filler” or a “vampire face-lift.”
Volume deﬁciency in areas of deeper folds, such as the nasolabial folds (NLFs), typically is treated with injectable dermal ﬁllers. Disadvantages include the transient effects of temporary, resorbable ﬁllers and foreign body reactions such as encapsulation, granuloma formation, and chronic or delayed infections, in the case of injectable permanent ﬁllers. While some injectable soft tissue ﬁllers currently available (e.g., poly-L-lactic acid) rely on host tissue ﬁbrotic response to produce volume enhancement, they still utilize synthetic, nonbiologic implantable materials. An autologous source for promotion of soft tissue deposition in areas of depletion is desirable.
Effects of PRP
Numerous proteins are contained within the a granules of platelets that increase the healing process. These proteins include transforming growth factor (TGF)-b (including b1 and b2 isomers), platelet factor 4 (PF4), interleukin (IL)-1, platelet-derived angiogenesis factor (PDAF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), platelet-derived endothelial growth factor (PDEGF), epithelial cell growth factor (ECGF), insulin-like growth factor (IGF), osteocalcin, osteonectin, ﬁbrinogen,vitronectin, ﬁbronectin, and thrombospondin (TSP) The many proteins secreted by the activated platelets inﬂuence many aspects of wound healing. PRP increased the expression of type I collagen, MMP-1, and mRNA in human dermal fibroblasts. PRP induces the synthesis of new collagen by fibroblasts.
Recent studies have used topical growth factors to improve the smoothness and decrease wrinkles in skin. Because PRP contains numerous growth factors, it has been studied in skin rejuvenation applications.
CLASSIFICATION OF PLATELET CONCENTRATES
The development of a wide range of preparation protocols, devices and centrifuges for varying indications have led to a number of different platelet concentrates, unfortunately all under the same name as PRP. There are theoretically four subsets of platelet-rich plasma: pure PRP, leukocyte and PRP (L-PRP), plate-let-rich ﬁbrin matrix (PRFM), and leukocyte- and platelet-rich ﬁbrin matrix.
Platelet-Rich Fibrin Matrix
Clinical results reported with the use of PRP have been equivocal, possibly because most growth factors, such as TGF-b and PDGF, are released immediately from the PRP platelets, with significant reductions at days 3, 7, and 14. Whereas the fibroblast and collagen synthesis occur after inflamatory stage and peaks at 7-10days by which time effect of PRP would have gone.In addition to platelets and their products, the natural wound response requires the presence of a fibrin matrix, which enhances the delivery of growth factors. Fibrin mediates the adhesion of fibroblasts and other cells to the injured site. Furthermore, basic fibroblast growth factor (bFGF) has a high binding affinity specifically for fibrin and fibrinogen.
Several factors make PRFM a better product than PRP for use in facial plastic surgery. As mentioned earlier, PRP releases growth factors mainly in the first day. In contrast, the action of PRFM is more steady and sustained, yielding increased and sustained concentrations of growth factors during the more crucial time of wound healing after the initial acute inflammatory phase. It is suggested that the natural fibrin framework in PRFM protects the growth factors from proteolysis.
Peripheral blood is drawn from the patient into a vacuum collection tube containing a thixotropic separator gel. This tube is centrifuged for 6 minutes at 1100 g, which yields a supernatant plasma/platelet suspension and the cellular components (erythrocytes and leukocytes) below the separator gel. The plasma/platelet suspension is transferred to a second vacuum tube containing calcium chloride, which initiates the polymerization of fibrin. This polymerization process is completed in about 10 to 12 minutes and the platelet-rich fibrin matrix can be injected through a 30-gauge needle before full polymerization.
Correction of Crow’s Feet
A single treatment of crow’s feet typically requires between 0.75 and 1.25mL of PRFM per side. A 30-gauge needle is placed in each individual rhytid and is advanced within the dermal layer. PRFM is injected in a lineal retrograde fashion within each rhytid.
Treatment of Tear Troughs and Suborbital Hollows
A 27-gauge needle is advanced through the skin along the area of suborbital volume deficiency. Careful linear retrograde injection of PRFM below and above the orbicularis oculi muscle is performed to achieve a smooth and even volume augmentation. Tear troughs are typically treated with 0.75 to 1.00 mL, whereas the remaining suborbital hollow requires about 1.00 mL.
Glabellar furrows may be spread apart using the nondominant hand while each individual wrinkle is intradermally injected with PRFM using a 30-gauge needle. Once the rhytids are effaced, additional PRFM may be injected subdermally for volume augmentation. Treatment of a typically glabella requires 0.50 to 0.75 mL.
A single treatment typically requires 1.50 to 2.50 mL of PRFM per side. A 27-gauge needle is advanced through the skin and into the malar fat pad. Injection of PRFM is performed linearly in a fan pattern as the needle is withdrawn, depositing PRFM within the malar fat as well as in the immediate subdermis.
Zygomatic Arch Enhancement
A single treatment per side typically requires 1 to 1.75 mL of PRFM. The needle is advanced through the skin and parallel to the zygomatic arch in a subcutaneous plane.
Correction of Nasolabial and Marionette Folds
A 27-gauge or 30-gauge needle is used to inject PRFM into the desired areas at the dermal-subdermal layer in a fanlike pattern. In the case of marionette folds, injection should ideally be limited to a triangular area with its base along the white roll of the lower lip. Typical volumes of PRFM used are 1.50 to 2.00 mL for nasolabial folds and 0.75 to 1.25 mL for marionette folds,per side.
Treatment of Rolling and Boxcar Acne Scars
A modified subcision technique is used. A 21-gauge needle is passed through the skin and advanced at the dermal-subdermal layer until the tip rests below the site to be corrected. The sharp edge of the needle bevel is then swept from side to side to sharply divide the subdermal scar tissue tethering the acne scars. PRFM is then injected in a fan pattern into the potential space created at the desired site. Another needle entry site is then used to create a crosshatched pattern of threads of dermal-subdermal augmentation. Again, overcorrection is desirable, because the plasma is quickly absorbed. The volume of PRFM used varies based on the area of acne scarring to be treated, but 2 to 2.50 mL are typical for acne scarring in the cheek.
Platelet-rich plasma and hyaluronic acid
Loss of viscoelasticity is one of the primary signs of skin aging, followed by the appearance of visible wrinkles. A key molecule involved in maintaining skin hydration is hyaluronic acid (HA).The HA concentration in the skin is determined by the complex balance between the skin’s synthesis, deposition, association withcellular structures and degradation.
Recent basic research supports the idea that HA and PRP treatments can be advantageously associated without altering the original relevant characteristics of both products. When both products are injected, their effects might be additive to enhance the anabolic function of dermal ﬁbroblasts.
PRP with fat graft
Adipose tissue has become the autologous filler of choice in plastic, reconstructive, and aesthetic surgery. After fat grafting, there is a progressive improvement of the skin texture,elasticity, and color over a few months. Therefore,
adipose tissue seems to be not only a simple filler but also a dynamic filler with two types of different and supplementary effects, the volumetric effect and the regenerative effect.
The adipose-derived stem cells have demonstrated their capacity to elicit a regenerative and angiogenic response through autocrine, paracrine, and direct cell-to-cell interactions. Also, there is evidence that the mechanism of repair or regeneration of the overlying skin may be related to stem cells or adipocyte breakdown products within the fat grafts. Stem cell harvesting is a time consuming and costly affair. Replacement of Stem cells with PRP has given promising results. A 1:1 Fat and PRP is a ideal filler for volume enhancement.
Laser resurfacing with PRP
” Clinical experience has shown combining Botox and PRP treatment in same sitting can reduce the effect of Botox thus should not be performed together”