July 2022 Vol 15* Issue-6 Total Pages : 24 100 Blister Grafting For Lip Area Is a Better Option Than Punch Grafting For Better Cosmetic Results PRP in RecentDermatology:AestheticUpdates MUMBAI 2022 1 Day Conference, Hands on Workshop and Exhibition www.aestheticcon.com This Event is Supported by International Society of Cosmetic Dermatology Application & Research Pre - Conference Announcement
ROcclusiveHumectantEmollient Power of MOISTURISERS E RAT NLE GP EM OO FC INGREDIENTS Cetyl alcohol, Propylene glycol, Aloe Barbadensis Leaf Extract, Stear yl alochol, Avena sativa (Oat) Kernel Oil for product inquiries please contact 9886444717
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Aesthetic Dermatology works to heal skin and hair concerns in a way that they appear healthier, even going as far as boosting self-confidence of patients who have been unhappy with the way they look. This issue we got article on PRP in Aesthetic Dermatology and Lip Vitiligo etc. - Dom Daniel Executive Editor & Publisher
July 20224
Cosmetic and Aesthetic Dermatology is an arm of the science that emphasises on improving the appearance. It is a specialty of medicine involved to treat the skin, hair, or nails using a treatment that is meant to improve a patient’s appearance rather than treat a disease. Cosmetic surgery and aesthetic procedures have become a rising demand of the population to stay young. They are becoming increasingly popular across all sections of the population. Due to this increasing demand for aesthetic procedures, it is not uncommon for patients to encounter a menu of aesthetic supplies and procedures. Cosmetic and aesthetic treatments include skin rejuvenation, antiwrinkle treatment, acne scar treatment, pigment removal, stretch mark removal, hair restoration, hair removal, skin whitening, lip enhancement, tattoo removal, nonsurgical facelift, fat removal, anti-aging treatment.
EXECUTIVE EDITOR & PUBLISHER Dom Daniel ADVISORY BOARD Dr. Ashish Shetty Dr. Pavan Kumar Dr. Nithin S.U. Dr. Pavan Raj Dr. Samipa Mukherjee Dr. Manjunath B.M. Dr. Anuradha Jindal Dr. Melcam Noronha Dr. Aarti Priya Dr. Dilip Gowda CORPORATE OFFICE 22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA. EMAIL:Website:theaestheticiansjournalindia@gmail.comtheaestheticiansjournal.com
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Printed, Published, Edited and Owned by Dom Daniel Printed at Swastik Printer, Gala No.9 & 10, Vishal Industrial Estate, Bhandup (West), Mumbai- 400078. Published at 22 Shreeji Bhavan, 275/279, Samuel Street, Masjid Bunder (West), Mumbai - 400003. India. “The Aestheticians Journal” takes no responsibility for unsolicited photographs or material ALL PHOTOGRAPHS, UNLESS OTHERWISE INDICATED, ARE USED FOR ILLUSTRATIVE PURPOSE ONLY. Views expressed in this Journal are those of the contributors and not of the publisher. Reproduction in whole or in parts of texts or photography is prohibited. Manuscripts, Photographs and art are selected at the discretion of the publisher free of charge (advertising excluded). Whether published or not, no material will be returned and remains the property of the publishing house, which may make use of it as seen fit. This may include the withdrawal of publication rights to other publishing houses. All rights reserved. Reproducing in any manner without prior written permission prohibited. Published for the period of July-2022
The Social Implications of Aesthetic Dermatology
Dr. Vivekananda Ittigi, MBBS, DDVL, (MD), FRGUHS July
Recent Updates Dr.Vivekananda IttigiMBBS,DDVL,(MD),FRGUHSDermatologist,Cosmetologist andDermatosurgeonHassan,Karnataka Introduction Platelet Plasma (PRP) avolume the plasma fraction ofautologous blood the platelet DermatologyDentistry,toolsbecameinµLconcentration>10,00,000platelets/thebaseline.Itwasfirstsurgery,sportsmedicine.ItanemergingtherapeuticmanyindicationsMaxillofacialsurgery,andAesthetics.
Dr. Nirmalya Malakar, MBBS, DDVL PRP in Aesthetic Dermatology: Recent Updates
Pathophysiology of PRPTherapy Pathophysiology PRP therapyincludes:Growth factors (GFs) inplatelet–granulesPlatelet-derived growth factor(TGF-factor(PDGF)Insulin-likegrowthfactor(IGF)Vascularendothelialgrowth(VEGF)Transforminggrowthfactor) Platelet- derived angiogenicchloridethrombin,Platelet(PDAF)activation-initiatedcollagencalcium Physiological ActionsGrowthFactors Platelet-derived growth factor(PDGF) ᵦᵦ Chemotactic,mitogenic Vascular endothelial growthfactor (VEGF) Chemotactic,mitogenic, angiogenesisEpidermal growth factor (EGF):Mitogenic,proangiogenesis Fibroblast growth factor (FGF)Tissueregeneration Hepatocytegrowthfactor(HGF)Tissueregeneration TransformingGrowthFactor(TGF 2):Chemotactic,mitogenic, regulateregulatematrixproteincomposition,cellularactivityPRP can augment collagenremodeling:Stimulation removalthe photodamaged extracellularmatrix componentsand inducingsynthesis the collagen bydermal fibroblasts. Increasedproliferation of humanfibroblasts, increased expressionof matrix metalloproteinase(MMP-1 and MMP-3), removalphotodamaged ECM, increasedproduction of procollagen typepeptide expression collagen AestheticsDermatology 14
medical modalities of approach,in thesecases,surgeryoffershope. Vitiligo of can causeemotional distress. Medicaltherapies often ineffectiveto complete lack of pigmentreservoir affected areaslips. almostimpossible regain usingwasandprocedureSBGprocedurestransplantationmedicalaredoeswithlayer,reservoir,TheyphotochemotherapyMelanocytespigmentwithconservativemethods.arestimulatedduringinvitiligo.migratehairspreadcentrifugallyfrominfundibulumtobasalandrecolonizeepidermisfunctionalpigmentcells.occurtheastherehairfollicles,explainingwhmanagementoftenltsaslowpoorresponse.Thus,melanocytestattooingaremostlogicalthesecases.wascarriedusingdescribedbyGuptaGoel,wheresuctionsyringeattachedthepullingsyringethree-wayconnector.
PRPinAesthetics Dermatology
Grafting Grafting Results
Dr.Nirmalya MalakarSparshDirectorM.B.B.S;D.D.V.LSkin,AestheticandLaserClinicAgartala,Tripura SummeryLip vitiligo is ally resistantmedical modalities of treatment,andin these surgeryoffershope. Suction blister grafting(SBG)hasbeen since forvitiligo high success.is cosmetically disfiguringcondition commonlyin dermatological outpatientclinics. Prevalence calculatedfrom dermatological outpatientrecordsranges between and1.8%globally,withMexico Indiahaving highestincidence thiscondition. Vitiligo a profoundimpact on self-image, self-esteem,interpersonal relationships.addition,the atient experiencestigmatization, embarrassment,and self-consciousness aboutandSitesembarrassmentwithappraisal,ignorance,society.posesbothvitiligo.Evenmarriageproposalssexesaffected,andproblemparentsandespreadprejudices,taboos,ofscientificconfusionofleprosy,makeaforpatient.suchjoints,areas,areusuallyresistant
08
Blister Grafting For Lip Area Is a Better Option Than Punch Grafting For Better Cosmetic Results
0814
Blister Grafting For LipAreaIs a Better Option Then PunchGrafting For Better Cosmetic Results
July 20226 Editorial Board Dr. Vivekananda Ittigi MBBS, DDVL, (MD), FRGUHS Dermatologist, Cosmetologist and Dermatosurgeon Hassan, Karnataka Dr. Nirmalya Malakar MBBS, SparshDirectorDDVLSkin,Aesthetic and Laser Clinic Agartala, Tripura
July 2022 7 MOISTURISERS E RAT NLE GP EM OO FC Caprylic Capric triglyceride, Oz ok erite Wax, Coper nicia Cerif era Cera, Butyrospermum P arkii Butt er, Simmondsia Chinensis Seed (JOJOBA) Oil, Olea Europaea (OLIVE) Oil, Macadamia Ternif olia Seed Oil, Persea Gr atissima, Prunus Armeniaca (Apricot) Kernel Oil, Euphorbia Cerif era Cer a, Alaria Esculenta Extract, Tocopherol, Ethylhexyl Methoxycinnamate, 2 Hydroxy 4 Methoxybenzophenone
Grafting For Better Cosmetic Results
Dr. Nirmalya Malakar MBBS, SparshDirectorDDVLSkin,Aesthetic and Laser Clinic
Agartala, Tripura Summery Lip vitiligo is usually resistant to medical modalities of treatment, and in all these cases, surgery offers a hope. Suction blister grafting (SBG) has been tried since long for lip vitiligo with high rate of success.
July 20228
Blister Grafting For Lip Area Is a Better Option Than Punch Grafting For Better Cosmetic Results
Vitiligo is a cosmetically disfiguring condition that is commonly seen in Indian dermatological outpatient clinics. Prevalence calculated from the dermatological outpatient records ranges between 0.2% and 1.8% globally, with Mexico and India having the highest incidence of this condition. Vitiligo has a profound impact on self-image, self-esteem, and interpersonal relationships. In addition, the patient can experience stigmatization, embarrassment, and self-consciousness about vitiligo. Even marriage proposals of both the sexes are affected, and it poses a problem to the parents and society. Widespread prejudices, ignorance, taboos, lack of scientific appraisal, and confusion of vitiligo with leprosy, all make it a social embarrassment for the patient.
Blister Grafting For Lip Area Is a Better Option Than Punch
Sites such as joints, acral areas, and lips are usually resistant to medical modalities of approach, and in all these cases, surgery offers a hope. Vitiligo of lips can cause great emotional distress. Medical therapies are often ineffective due to complete lack of pigment cell reservoir in the affected areas of lips. It is almost impossible to regain pigment with conservative methods. Melanocytes are stimulated during photochemotherapy in vitiligo. They migrate from hair follicle reservoir, spread centrifugally from the infundibulum to the basal cell layer, and recolonize the epidermis with functional pigment cells. This does not occur on the lips as there are no hair follicles, explaining why medical management often results in a slow or poor response. Thus, transplantation of melanocytes and tattooing are the most logical procedures in these cases. SBG was carried out using the procedure as described by Gupta and Goel, where suction syringe was attached to the pulling syringe using a three-way connector.
Great advances have been made in surgical options for vitiligo treatment in the recent years. It is essential to take into consideration size and area affected, age of patient, patient’s attitude, requirement and expectations, facility available, expertise of surgeon, and cost before opting for surgery. Surgical modalities are broadly classified into grafting (including tissue and cellular grafts) and non-grafting techniques (including graftsitesofpigmentscombinationsinvolvesMicropigmentationcosmetichence,characteristicaremethods,inmaybutisacceptance.methodsite.regulateddevelopmentdifferentiation,fatcarrygrafting,graftingTissueconsumingtechnicalhaveminimalexcellentusedAlthoughphototherapy,excision/closure,micropigmentation,dermabrasion,andlasers).cellulargraftscanbetotreatlargerareaswithcosmeticoutcomeandsideeffectprofile,theythedisadvantagesofrequiringexpertiseandbeingtime-andcostly.grafts,suchasminipunch(MPG),split-thicknessandhairfolliclegrafting,dermisandsubcutaneousinadditiontoepidermis.Thepigmentation,andofepidermalcellsarebythedermisofdonorPunchgraftingistheeasiestbuthastheleastcosmeticSplit-thicknessgraftingquickerandyieldslargegrafts,itneedssurgicalskillasgraftbethickerandmayresultmiliaformation.Inboththeepidermisanddermisgraftedsothegraftretainsofthedonorsite;thepigmentationleadingtomismatchmayoccur.ortattooingintroducingvariousofinert,artificialintothemid-dermislevelthelesion.Itisindicatedinspecialsuchasangleoflipswhereretentionispoorandin
Before Figuretreatment2:
The suction syringes used were of 10mL, and the syringe used for creating vacuum was of 50mL. The three-way connector was used to control the negative pressure. After an average time of 1.5–2h, the blisters were formed, and they were then removed using a curved scissor to a glass slide with the dermal side facing up. The grafts were placed in normal saline till the recipient area was prepared. Manual dermabrasion using Manekshaw’s dermabradors was carried out on the angles of the lip after infiltration with 2% lidocaine. The grafts were placed on the dermabraded site, and surgical glue was applied to the periphery of the grafts. The patients were asked to minimize lip movements and only liquid diet was advised for 3 days using a straw. After 3–4 days, the grafts tend to fall off on their own when normal food intake was resumed in all cases. All the patients were asked to receive topical psoralen followed by sun exposure (PUVASOL) after applying methoxsalen (0.75% w/v diluted with water in the ratio of 1:20) on the treated areas followed by sun exposure of 5 minutes, starting 7 days after grafting was carried out for 12 weeks. They were asked to follow-up at 3, 6, 12, 18, and 24 months to assess the outcome of the Inprocedure.mycase 19 year old female with other negative family history presented with lower lip vitiligo since 3-4 years duration. Initial medical mode of treatments were tried with no success. Then Suction Blister Grafting was performed where donor site was from upper thigh. She gained complete repigmentation on the vitiligo patch after 3 months of SBG with PUVA therapy. Cosmetic outcome was excellent in that case.
Before and 3 months after treatment
Discussion
July 2022 9
Figure
1: Suction blister (A) During blister formation (B) After fully developed blister A BB Blister Grafting For Lip Area Is a Better Option Than Punch Grafting For Better Cosmetic Results
6. Parsad D. Mucosal vitiligo. In: Picardo M, Taieb A, editors. Vitiligo. 1st ed. BerlinHeidelberg Germany: Springer; 2010. pp. 7.57–9.Singh
SBG involves use of creating negative pressure by applying suction on the donor area, which causes a physiological split at the level of dermoepidermal junction. This results in very thin epidermal grafts, which are then transferred to the recipient site and fixed. The grafts, being purely epidermal, adopt the characteristics of the recipient area producing excellent color match and cosmetic outcome. It is most suitable for facial vitiligo and areolar involvement. The major drawbacks are that it is a timeconsuming process and only small areas can be treated.
14. Khunger N, Kandhari R. Thin split thickness skin grafting for vitiligo. In: Venkataram M, editor. ACS(I) textbook of cutaneous and aesthetic surgery. 2nd ed. New Delhi, India: Jaypee Brothers Medical Publishers; 2017. pp. 426–33
12. Gupta S, Sandhu K, Kanwar A, Kumar B. Melanocyte transfer via epidermal grafts for vitiligo of labial mucosa. Dermatol Surg. 13.2004;30:45–8.LahiriK. Minigrafting for vitiligo. In: Venkataram M, editor. ACS(I) textbook of cutaneous and aesthetic surgery. 2nd ed. New Delhi, India: Jaypee Brothers Medical Publishers; 2017. pp. 408–17.
15. Savant SS. Tattooing. In: Savant SS, editor. Textbook of dermatosurgery and cosmetology. 2nd ed. Mumbai, India: JASCAD; 2005. pp. 337–44.
July 202210
Blister Grafting For Lip Area Is a Better Option Than Punch Grafting For Better Cosmetic Results situations that need urgent pigment correction such as upcoming major life events. It is particularly useful in Asians and Africans. The drawback of the procedure is deeper migration of the pigment giving the treated site a washedoff appearance and formation of pigment-induced foreign body granuloma. Francis et al. concluded that micropigmentation is a safe, effective, and cosmetically acceptable option for vitiligo of lateral lower lip as it is a relatively easy procedure with immediate and fairly long-lasting results.
2. Sangma LN, Nath J, Bhagabati D. Quality of life and psychological morbidity in vitiligo patients: a study in a teaching hospital from north-east India. Indian J Dermatol. 3.2015;60:142–6.HedayatK, Karbakhsh M, Ghiasi M, Goodarzi A, Fakour Y, Akbari Z, et al. Quality of life in patients with vitiligo: a crosssectional study based on vitiligo quality of life index (vitiqol) Health Qual Life Outcomes. 4.2016;14:86.Rajaram M, Alagarsamy S, Sundarapandiyan S, Selvaraj U. Autologous miniature punch skin graft procedure in 25 cases of stable vitiligo. Int J Sci Stud. 5.2017;4:112–6.KoronneRV, Sachdevo KG. Vitiligo. Int J Dermatol. 1998;27:676–81.
AK, Karki D. Micropigmentation: tattooing for the treatment of lip vitiligo. J PlastReconstrAesthet Surg. 2010;63:988–8.91.
9. Gupta S, Goel A. Suction blister epidermal grafting. In: Gupta S, Olsson MJ, Kanwar AJ, Ortonne JP, editors. Surgical management of vitiligo. 1st ed. Oxford UK: Blackwell; 2007. pp. 96–107.
References 1. Zhang Y, Cai Y, Shi M, Jiang S, Cui S, Wu Y, et al. The prevalence of vitiligo: a metaanalysis. PLoS One. 2016;11:e0163806.
Conclusion SBG is an easy and cost-effective method of repigmentation of a difficult-to-treat site for vitiligo such as angle of lip. Quality of repigmentation matches nicely with the surrounding skin. Followup at 6 months has a high rate of complete repigmentation. Patients need to be followed up for a loss of pigmentation. Regrafting can be offered in cases where pigment is lost during follow-up after assessing the disease activity.
10. Venkataram M, Lahiri K. Overview of vitiligo surgery. In: Venkataram M, editor. ACS(I) textbook of cutaneous and aesthetic surgery. 2nd ed. New Delhi, India: Jaypee Brothers Medical Publishers; 2017. pp. 401–7.
11. Gontijo RM, Gontijo RD, Gontijo RC. Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo. An Bras Dermatol. 2017;92:312–8.
IADVL Dermatosurgery Task Force. Parsad D, Gupta S. Standard guidelines of care for vitiligo surgery. Indian J DermatolVenereolLeprol. 2008;74:S37–45.
The researchers' findings may form the basis for developing new treatment, diagnostic and prevention Thestrategies.studyconducted by the research group with focused on the S100A9 gene. The team has discovered that the severity of psoriasis (Ps) and psoriatic arthritis (PsA) can be reduced by inhibiting S100A9 systemically throughout the whole body rather than locally on the skin.With this finding, the researchers are laying the foundation for a paradigm shift in the treatment of Ps and PsA. Researcher said "Our study is an important step towards the development of targeted therapeutic options in the form of drugs that act systemically rather than locally on the skin. New diagnostic and prevention strategies can also build on the study.
Routine use of emollients can prevent the initial development of atopic dermatitis
Scientists discover a key starting point for inhibiting inflammation in psoriasis and psoriatic arthritis
As shown by previous basic research, the symptoms of psoriasis disappear when the S100A9 gene is deactivated in all cells of the body. The recent preclinical experiments were able to shed light on the particular influence that the skin and immune cells in which S100A9 is produced have on disease severity. We now know that the inflammatory responses in psoriasis and psoriatic arthritis are enhanced when S100A9 is only inhibited in skin cellsresearch summarizing the main finding of the study. Therefore drugs inhibiting S100A9 have to be administered systemically in the form of tablets or drips.
News
Based on these figures, early emollient use was associated with a 30% reduction in risk for AD (RR = 0.7; 95% CI, 0.51-0.95), which reached significance, reflecting the need to standardize protocols to truly determine the effectiveness of emollient use in preventing AD, the researchers said.
Atopic dermatitis is an inflammatory skin disease with early onset. It is a common, chronic, relapsing, inflammatory skin disease that primarily affects young children. AD affects between 15% and 30% of children, with up to 60% of cases presenting in the first year of life and 85% presenting within the first 5 years. Prevalence is increasing in developed and developing countries. It has a significant impact on health care workers, financial, social and psychological burdens on health care workers, patients and their families. The outside-in hypothesis posits that disrupted skin barriers play an important role not only in the initiation of AD but also in the entire atopic march of food allergies, allergic rhinitis and bronchial Accordingasthma.toarecently
Psoriasis is one of the most common chronic inflammatory skin conditions that can also spread to the joints. Triggers for the disease, which usually first appears in adulthood, include stress and UV radiation. However, individuals can also be genetically predisposed to developing Ps. S100A9 activation in skin and immune cells has been identified as a risk factor for the development of Ps and/or PsA.
published study showing that the routine use of emollients can prevent the initial development of atopic dermatitis by ameliorating the skin barrier defects brought about by a change of lipid and protein composition and skin disbalances. Emollient use remains a cornerstone in management of atopic dermatitis. The reviewed studies comprised 2,805 infants at high risk for AD and infants with a parent or sibling with atopic disease. According to the researchers, early emollient use led to a 21% risk reduction in the development of AD (RR = 0.79; 95% CI, 0.57-1.08), which did not reach significance. However, there were differences in sample size, length of study, timing of initiation, control and binding, and other design details that may have accounted for the increased heterogeneity between the studies, the researchers said. Also, the researchers found that the lack of a significant preventive effect likely was due to the studies using different emollient types, frequencies of application and timing of application commencement. The researchers then conducted a subgroup analysis of six of the studies with a pooled population of 1,633 infants, including 814 in an intervention group and 819 in a control group, with 182 (22%) in the intervention group and 224 (27%) in the control group developing AD.
July 2022 11
Around 250,000 people in Austria suffer from psoriasis. One third of them develop inflammation in their joints (psoriatic arthritis) as a result of the chronic skin condition. As part of a study, a research team has now discovered a key starting point for inhibiting inflammation in both psoriasis and psoriatic arthritis.
July 202212 To the point: A unique knowledge sharing platform Skill up: Hands on training by Masters in Aesthetic Dermatology with CertificateInternationalExpo: Update yourself of the New Products and Latest Devices AESTHETICCON, a 1 Day Conference, Hands on Workshop and Exhibition focused on practical learning experiences in Aesthetic Dermatology. Brought to you by “The Aestheticians Journal” serving you since 2010 with 12 years in print and digital publications and over a 100 educational workshops and conferences. AESTHETICCON Mumbai 2022 is just the event for you with practical insights shared in the Conference, tips while training in the Hands on workshop and interaction with product and device Spendmanufacturers.theday catching up and meeting with your fellow Dermatologists colleagues. Aestheticcon Mumbai 2022 a must attend event. For further details and to regiisster for the conferrence and hands on workshop call us at +91 8928866175 www.aestheticcon.com MUMBAI 2022 16th October' 2022 1 Day Conference, Hands on Workshop and Exhibition This Event is Supported by International Society of Cosmetic Dermatology Application & Research
July 2022 13 1 Day Conference, Hands on Workshop and Exhibition MUMBAI 2022 16th October'2022 Advisory Board Dr. Abhishek De MDD FAGE SCE (Dermatology) FRCP Edin Consultant Dermatologist Aesthetician and Laser Surgeon Wizderm, Kolkata Dr. Meera James MD Beau Aesthetica The Cosmetic Dermatology Clinic and Academy, Kerala Dr. Satish Bhatia MD Dermatologist and CCutaneous Surgeon Dermdestination Mumbai Dr. Farida Modi MD Dermatologist and Cossmetologist Dermacare Skin Clinic & Cosmetic Center Mumbai REGISTRATION FEES & DETAILS Conference registration fees: Rs.2500/Dr+ 18% GST* (Early bird For payments received till 31st August) Rs.4000/Dr +18% GST* (For payments received between 1st September to 30th September s/t availability) *Registration fee includes access to conference and lunch ONLY 1. Botulinum toxin : Basic Indications 2. Botulinum toxin : Advanced Indications 3. Fillers 4. Thread Lifts HANDS ON WORKSHOP on Aesthetic Dermatology Procedures with INTERNATIONAL CERTIFICATE from an INTERNATIONAL SOCEITY OF COSMETIC DERMATOLOGY Rs.5000/Workshop +18% GST#(Early bird For payments received till 31st August) Rs.7500/Workshop +18% GST#(For payments received between 1st September to 30th September s/t availability) #Registration fee include access to individual registered Hands On Workshop only, conference, lunch and CERTIFICATE from INTERNATIONAL SOCIETY OF COSMETIC DERMATOLOGY APPLICATION & RESEARCH (www.internationalsocietyofcosmeticdermatology.com) Topics of Hands On Workshop Terms & Conditions: 1. Only for Dermatologist. Please share your PG in Dermatology Credentials while registering 2. Compulsory prior registration required. On the spot registration not available 3. Hands On Workshops have limited seats and will be available on first come first serve basis on prior registration only. 4. Hands On Workshops may extend beyond stipulated time, causing them to overlap inadvertently. 5. Cancellations not permitted. No refunds will be made Contact us Contact. No. +91 8928866175 Email : aestheticconindia@gmail.com www.aestheticcon.com This Event is Supported by IInternational Society of Cosmetic Dermatology Application & Research
• Transforming growth factor-ᵦ(TGF-ᵦ)
• Platelet- derived angiogenic factor (PDAF) • Platelet activation-initiated by thrombin, collagen or calcium chloride Major Physiological Actions of Growth Factors
PRP in Aesthetic Dermatology: Recent Updates
• Platelet- derived growth factor •(PDGF)Insulin-like growth factor (IGF)
July 202214
Hassan, Karnataka Introduction Platelet Rich Plasma (PRP) is a volume of the plasma fraction of autologous blood with the platelet concentration >10,00,000 platelets/ µL from the baseline. It was first used in oral surgery and sports medicine. It became an emerging therapeutic tools in many indications in Dentistry, Maxillofacial surgery, Dermatology and Aesthetics.
MBBS, DDVL, (MD), FRGUHS
•includes:Growth factors (GFs) stored in platelet – granules
• Transforming Growth Factor (TGF ᵦ1 and ᵦ2): Chemotactic, mitogenic, regulate matrix protein composition, regulate cellular activity PRP can augment collagen remodeling: Stimulation of removal of the photodamaged extracellular matrix (ECM) components and inducing synthesis of the new collagen by the dermal fibroblasts. Increased proliferation of human dermal fibroblasts, increased expression of matrix metalloproteinase (MMP-1 and MMP-3), removal of photodamaged ECM, increased production of procollagen type I peptide and expression of collagen type I, alpha-I - help in synthesis of new collagen and increased expression of G1 cell cycle regulators which helps in accelerating wound healing.
Dr. Vivekananda Ittigi
• Vascular endothelial growth factor (VEGF): Chemotactic, mitogenic, pro angiogenesis
• Fibroblast growth factor (FGF): Tissue regeneration • Hepatocyte growth factor (HGF) : Tissue regeneration
Dermatologist, Cosmetologist and Dermatosurgeon
PRP in Aesthetic Dermatology: Recent Updates
• Vascular endothelial growth factor (VEGF)
• Epidermal growth factor (EGF): Mitogenic, pro angiogenesis
Pathophysiology of PRP Therapy Pathophysiology of PRP therapy
• Platelet-derived growth factor (PDGF):ɑɑ, ɑᵦ and ᵦᵦ: Chemotactic, mitogenic
• PRP
PRP in Aesthetic Dermatology: Recent Updates observed carefully. The optimum temperature regulations (20 to 22°C) has to be observed. It is prepared with an anticoagulantanticoagulant citrate dextrose solution formula A (ACD-A) or sodium citrate.
• Vacutainer
method • Using commercially
Vacutainer Technique PRP Method: Venipuncture-obtains WB (whole blood) in the acid citrate dextrose (ACD) tubes. Centrifuge blood using ‘soft’ spin (1500rpm × 5 min). Transfer supernatant plasma containing the platelets into another of the sterile tubes (without
Figure 2: Preparation of PRP
Techniques of Preparation technique method/buffy coat available syringe technique
Figure 1: Principle of PRP procedure
July 2022 15
Preparation of Platelet Rich Plasma Day care process is extremely important to be maintained at all times. The patient consent should be in place before hand itself. Strict aseptic conditions should be
PRP kits • Modified
Basic Principle of PRP Procedure Centrifugation separates blood components due to their varying specific gravities. RBCs (Red blood cells)—heaviest, followed by WBCs (White blood cells), platelets— lightest. anticoagulant). Centrifuge tube to higher speed (hard spin) (3000 rpm × 10 min) lower 1/3rd is the PRP and upper 2/3rd is the platelet poor plasma (PPP). At bottom of tube, platelet pellets are formed. Remove the PPP and suspend platelet pellets in minimum quantity of the plasma (2–4 mL) by mildly shaking the tube. PRP Method After first spin step, WB (whole blood) separates out into 3 layers: upper layer- platelets and WBCs, intermediate thin layer- buffy coatricher in WBCs, bottom layermostly SecondRBCs.spin step, ‘G’ for the second spin is to be just enough to help formation of the soft pellets (erythrocyte-platelet) at bottom of tube. Upper portion of volume- PPP (platelet-poor plasma) is removed. Pellets are homogenized in lower third (5 mL of plasma) - platelet-rich plasma (PRP).
The commercial kits for PRP are too expensive. The BD vacutainer are sterile but not endotoxin tested. BD do not recommend them for human injection use. Hypodermis syringes are sterile and endotoxin tested and can be used for human use. Mototsugu Fukaya et al describe this technique which is mentioned below to obtain easy PRP. The material required for modified syringe technique is 5cc luer lock hypodermis syringes, syringe tip caps, 3-way connector, scalp vein set, sterile ACD-A solution.
WB to be stored at 20 to 24°C before centrifugation. Centrifuge the WB at ‘high’ speed. Three layers are then formed because of density; bottom layer- RBCs, middle layerplatelets and WBCs and top- PPP layer. From small volume WB (10 mL), a thin layer of buffy coat can be produced. Difficult to separate the thin buffy coat that contains mainly the WBCs and platelets, from underlying RBC layer.
Procedure Cut the finger guard of the syringes with sterile scissor so as to convert syringe into a tube. 0.5cc of ACD-A is taken in 2 tubes. 5cc of blood is withdrawn into syringes using a 19 no. scalp vein set. The tips of syringes are closed with sterile tip caps. The syringes are directly kept into the centrifuge with tips facing upward. Procedure of modified syringe technique
Figure 3: Buffy coat method
B C D FigureE5:
Buffy Coat Method
Modified Syringe Technique
Using Commercially Available PRP Kits WB Sterile endotoxin-free tubes are used; most of these methods use single spin method. The advantages of these kits are consistency in obtaining PRP, closed systems and no risk of environmental contamination.
PRP in Aesthetic Dermatology: Recent Updates
July 202216
FigureA
4: Modified syringe technique materials
Autologous PRP is a cost-effective, well-tolerated office procedure, to treat atrophic acne scars, having minimal or no serious side effects.
Once obtained, platelets in PRP can be activated by using 10% calcium solution in the ratio of 1:9 (0.1 mL of 10% calcium chloride to 0.9 mL of PRP) or by using thrombin. The active secretion of prepackaged GFs begins within 10 minutes of clot initiation and 95% of the secretion is completed within 1 hour. PRP must be used within 10 minutes of activation or else a gel would be formed making injection difficult. The concentrated platelets usually remain viable for upto 8 hours.
Study- Gulanikar AD, Vidholkar R. Efficacy of platelet-rich plasma in acne scars. ClinDermatol Rev 2019;3:109-14. All the types of scars showed response in terms of reduction in size. Rolling scars responded better to PRP as compared to boxcar and ice pick Injection Technique PRP is injected intradermally through a 30G needle (insulin syringe) deep to each scar going through normal skin. The technique used for injection was “linear threading and fanning”. The amount injected was sufficient to elevate the scar, and the end point was taken as blanching and elevation of the scar. The total amount of injection is 1–3 ml depending on the number of scars. After injecting, the site is gently massaged and compressed for a few seconds to control the bleeding. Ice pack was put when required. Topical antibiotic cream (fusidic acid 2% cream) was applied to the treated area. The patients were given topical sunscreen. The patients were reviewed on the 3rd day and on the 7th day for any side effects.
Figure 7: Acne Scars: Before and after Platelet-Rich Plasma
PRP in Aesthetic Dermatology: Recent Updates Patient-1
Topical application of PRP, intradermal injections by insulin syringes. The area to be injected is divided into grids and 0.1 mL is injected in each area, preferably 0.1 mL/cm2 as used in intralesional triamcinolone injection. Combination treatments with fractional lasers, fillers and autologous fat along with microneedling/dermaroller.
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A- Right Side B- Left Side InitialThirdPresentationSitting
First Follow up (After 1 Month)
Activation of Platelets
Techniques of PRP Delivery
Figure 6: Techniques of PRP delivery PRP in Acne-Scars
18 A- Right Side B- Left Side InitialThirdPresentationSitting First Follow up (After 1 Month) Figure 8: Acne Scars: Before and after Platelet-Rich Plasma A- Right Side B- Left Side PRP in Aesthetic Dermatology: Recent Updates InitialPatient-3Patient-2Presentation
Figure 9: Scars: Before and after Platelet-Rich Plasma
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Figure 11: Female patient with moderate acne scars showed good response on the right side of the face (treated with microdermabrasion and platelet-rich plasma) (a) Before treatment (b) After treatment with platelet-rich plasma.
Before After Figure 10: with PRP with PRP
Acne
Dermabrasion
Local injection can cause site reactions, pain or secondary infection. The rare complications like scar-tissue formation and calcification. Deposition of RBCs could lead to pigmentary changes due to deposition of hemosiderin.
Facial Rejuvenation
Dermaroller
The role of PRP in aesthetic medicine and skin rejuvenation has been an area of interest in the past few years. Possible improvement in skin elasticity and cosmetic appearance has been proposed to be due to a variety of mechanisms, including the increased proliferation of dermal fibroblasts; increased expression of matrix metalloproteinases (like MMP 1 and 3) which degrade and remove photodamaged extracellular matrix; increased collagen type 1 production, and modifying cell cycle regulators. PRP induces increased expression of extracellular matrix products like type I collagen, elastin, MMP1, and MMP2, thus promoting wound healing. Platelet-rich plasma is injected by multiple tiny punctures under the dermis, with or without topical local anesthesia. The process is painless if sufficient topical anesthesia is applied. When PRP is injected into the damaged area, it stimulates the tissue, causing mild inflammation that triggers the healing cascade. As a result, new collagen begins to develop. As this collagen matures, it begins to shrink and tightens and strengthens the skin. Improvement in skin texture and tone is noticeable within 3 weeks. Full collagen regenerationFigure 11
PRP in Aesthetic Dermatology: Recent Updates Dermaroller with PRP Patient-4Patient-5
First Follow up (After 1 Month)
Complications
The higher response of combined PRP and MDA (Microdermabrasion) in acne scar treatment may be explained by the synergy of the mechanical disruption of the stratum corneum by MDA with activated platelets, which modify the process of natural healing response by releasing cytokines and
PRP in Aesthetic Dermatology: Recent Updates
July 202220 requires 3 months. The PRP treatments can be used on all skin types and tones. Minimal swelling, bruising, and redness for the initial 12 to 24 hours are expected. A bruise at the needle stick site may be visible for 2 to 3 days. Swelling from the fluid is what the patient will notice first. During several weeks, the platelets stimulate growth factors, which assists in more collagen stimulation. Treatment results vary but last up to 18 months in most patients. Platelet Rich Plasma (PRP) is used for stimulation of both superficial and deep dermis layers. For superficial stimulation, the injection must be done in the superficial dermis. The PRP must be injected into the deep dermis or subdermal tissues when using as filler. The superficial injection might be done just like mesotherapy technique in order to improve the skin texture, volume and hydration. Side-effects might appear from mild bruising and occasional swelling to rarely infections. PRP is a form of bio-stimulator that is safe and creates an immediate, long lasting volumetric effect with natural looking results.
The latest facial rejuvenation procedure is the face lift which combines the power of new PRP technology and facial fillers to minimize the signs of facial aging. The PRP is combined with a facial filler and then re-injected into areas of concern around the face. The fillers provide an instant fill or volume correction and the PRP – injected above the filler– immediately kick-starts a skin regeneration process. Patients can see and feel the effects within minutes as their skin becomes tauter and smoother. The use of PRP with fillers not only enhances the skin tone and texture, but prolongs the effective filler correction for 3 to 6 months longer than when fillers are used alone.
Figure 12: Injection technique depending on the facial area PRP As A Filler
Figure 13: (a and b) Pre and post treatment of a 24 years old girl after 3 sessions of PRP Advantages of using PRP for aesthetic medicine include tissue regeneration and rejuvenation, PRP is nonallergenic, is an autologous physiological product, eliminates donor transmissible infections. Patient-6
Monthly intradermal injections of PRP in 3 sessions have shown satisfactory results in face and neck rejuvenation and scar attenuation. A study showed that a combination of fractional non-ablative (erbium glass) laser therapy with topical application of PRP, resulted in objective improvement in skin elasticity, a lower erythema index and an increase in collagen density. Histological examination showed an increase in length of dermoepidermal junction, amount of collagen and fibroblasts in the treated skin. Patients who don’t want or need fillers can benefit from PRP. The activated PRP serum can be injected just under the skin surface to stimulate the body to make a small amount of its own ‘filler’. Although this will not approximate the same results as one gets from a gel filler, some improvement in textural changes can be seen. PRP in combination with fractional ablative lasers (carbon dioxide) for deep wrinkles and severe photodamaged skin, has also been shown to reduce commonly encountered, transient adverse effects and decrease the downtime.
References 1. Vasudevan B, Chatterjee M, Shilpa K. Procedural Dermatosurgery: A Step by Step Approach. JP Medical Ltd; 2018 Apr 26. 2. Gulanikar AD, Vidholkar R. Efficacy of platelet-rich plasma in acne scars. ClinDermatol Rev 2019;3:109-14.
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3. Huang, I-Hsin; Huang, Yu-Chen (2019). Comment on “Platelet-rich plasma and its utility in the treatment of acne scars: A systematic review”. Journal of the American Academy of Dermatology, (), S0190962219327616–. doi:10.1016/j.jaad.2019.09.024
PRP in Aesthetic Dermatology: Recent Updates
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Microdermabrasion combined with PRP is markedly effective in the treatment of all types of scars (rolling, boxcar, and ice pick) while PRP alone is markedly effective only for the treatment of rolling scars. PRP can be used as an adjuvant therapy in facial fillers, microdermabrasion, microneedling and rejuvenation.
Conclusion The PRP has emerged as a newer therapeutic tool in the field of Dermatology and Aesthetics. Future of PRP is still full of challenges as there are very limited studies with credible evidences on different indications of Dermatology as well as Aesthetics. There are wide variations in the methods of preparation of PRP, in different studies and commercially available kits. In addition, there is lack of standardization in commercially available centrifuge machines which are being used for preparation of PRP in routine clinical setting.
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