The Effectiveness of Platelet-Rich Plasma in Hair Regrowth: A Case Presentation
Yellow
Lips Reshaping with Dermal Fillers
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Published for the period of June -2024
Advancements in Non-Invasive Cosmetic Procedures
In the dynamic landscape of aesthetic dermatology, the pursuit of beauty and rejuvenation has evolved significantly. Gone are the days when invasive surgeries were the primary option for those seeking to enhance their appearance. Today, a plethora of noninvasive procedures has revolutionized the field, offering effective and safe alternatives with minimal downtime. Non-invasive cosmetic procedures have seen significant advancements in recent years, offering patients effective and safe alternatives to traditional surgical treatments. These procedures, which include laser therapy, micro needling, chemical peels, dermal fillers, and platelet-rich plasma (PRP) therapy, are designed to improve the appearance of the skin and address various aesthetic concerns without the need for surgery.
Many condition affects millions of people worldwide, often causing physical and emotional distress. These non-invasive treatments offer a range of options for addressing various skin conditions, from acne scarring to general skin rejuvenation, providing effective solutions with minimal downtime and risks.
The non-invasive treatments help to stimulation of collagen production, improved skin texture and reduced appearance of acne scars. It is benefited to improved overall skin health.
The non-invasive cosmetic procedures have become increasingly popular due to their effectiveness, safety, and minimal downtime. Laser therapy, micro needling, chemical peels, dermal fillers, and PRP therapy etc offer patients a range of options to address their aesthetic concerns and achieve their desired results.
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Thanks & Cheers
- Dom Daniel Executive Editor & Publisher
The Effectiveness of Platelet-Rich Plasma in Hair Regrowth: A Case Presentation
Dr. Archit Aggarwal, MBBS, MD (Dermatology)
Yellow Peel……. A Boon or Bane?
Dr. Fariya Rasheed, MD, DVL
Lips Reshaping with Dermal Fillers
Dr. Komal Jerath, MD (Dermatology)
16th 5CC WORLD CONGRESS
THE BOUTIQUE INTERNATIONAL CONFERENCE ON Cosmetic & Aesthetic Energy-based Systems | Medical Dermatology | Aesthetic Gynecology Injectables for Aesthetic & Medical Use | Practice Management & Digital Marketing
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180 EXPERT SPEAKERS FROM ALL OVER THE GLOBE
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Editorial Board
Dr. Archit Aggarwal
MBBS, MD (Dermatology)
Chief Dermatologist
Kdc Skin Clinic
Faridabad
Dr. Fariya Rasheed
MD, DVL (OSMANIA)
Consultant Dermatologist
Dr. Fariya Rasheed's Skin, Laser and Hair Clinic
Hyderabad,
Dr. Komal Jerath
MD (Dermatology)
Dermatologist, Cosmetologist and Trichologist
Komal Skin and Cosmetology Clinic
Amritsar, Punjab
Advisory Board
DR. SATISH K M
DR. HAFSA ERAM
DR. NARENDRA P.
DR. MANJUNATH HULMANI
DR. ABDUL SAMAD
DR. VINAYAK V.
DR. POORNIMAMBAA
DR. NITHIN S U
DR. ABHISHEK SHETTY
DR. ANVITHA
DR. SOHANDAS SHETTY
DR. NESARGI
DR. HARISH PRASAD
DR. ASHISH SHETTY
DR. SAMIPA MUKHERJEE
DR. RAJENDRA BEN
DR. PRITAM SHAHANE
DR. RAJENDRA KUMAR PANIGRAHY
Leading the Way in Aesthetic Dermatology......
A CME on “Non-Invasive Face Sculpting & Body Contouring, Mumbai, May 14’ 2024
An exclusive session on non-invasive face sculpting and body contouring showcasing the latest technologies through live demonstrations, KOL user experience sharing, and interactive Q&A sessions for Brera Medical Technologies and Leader Medical Systems Pvt. Ltd was organized by “The Aestheticians Journal”
The faculty were the top Dermatologists viz Dr.Malavika Kohli, Dr.Farida Modi, Dr.Madhuri Agarwal , Dr.Batul Patel and Dr.Siddhi Tiwari along with Mr. Outhay Sananikone the International Business Development Director of Brera Medical Technologies who came down from Paris for this event.
The attendees were leading KOL in aesthetic and cosmetic Dermatology in Mumbai who were enthusiastic to be at the cutting-edge in technology in aesthetic treatments.
Opening Address
Live Demonstration
A Live demonstrations by Mr. Outhay Sananikone accompanied by Dr.Madhuri Agarwal who explained the salient features of the devices.
Panel Discussion
The Non-Invasive Face Sculpting and Body Contouring event was a resounding success, providing a comprehensive overview of the latest technologies in the field. The live demonstrations of JOVENA and BODYSTIM along with the user experience panel discussion offered valuable insights into the efficacy and application of these innovative devices. The event was executed by The Aestheticians Journal.
Mr.Dom Daniel, The Aestheticians Journal
Mr.Bharat Sachdev, Director of Leader Medical Systems Pvt. Ltd
Interactive Q&A session
L to R Mr.Bharat Sachdev, Dr.Batul Patel, Dr.Madhuri Agarwal, Dr.Malavika Kohli, Dr.Farida Modi, Dr.Siddhi Tiwari and Mr.Outhay
Presentation by Mr. Outhay Sananikone - International Business Development Director of Brera Medical Technologies
The Effectiveness of Platelet-Rich Plasma in Hair Regrowth: A Case Presentation
Dr. Archit Aggarwal MBBS, MD (Dermatology) Chief Dermatologist
KDC
Skin Clinic Faridabad
Introduction
Androgenetic alopecia (AGA) is a prevalent hair loss disorder influenced by genetic and hormonal factors, characterized by progressive thinning of scalp hair in a specific pattern related to androgens. By the age of 60, about 60% of men and 35% of women experience AGA.1,2
Male androgenetic alopecia (MAA) stands as the most prevalent form of hair loss in men, impacting 30-50% of individuals by the age of 50. Characterized by a predictable pattern affecting the temples, vertex and midfrontal scalp, MAA, despite often considered a minor dermatological concern, significantly affects self-image and contributes to anxiety and depression in some men. Beyond its dermatological implications, MAA is increasingly recognized as a risk factor for arterial stiffness and cardiovascular disease. Familial predisposition and racial variations underscore the hereditary nature of MAA,
with genetics accounting for approximately 80% of susceptibility. Normal androgen levels suffice to induce hair loss in genetically predisposed individuals. The key pathophysiological features involve alterations in hair cycle development, follicular miniaturization and inflammation. In MAA, the anagen phase progressively shortens, while telogen duration remains constant or lengthens, ultimately leading to insufficient hair length to breach the skin surface.1,2
Genetic and environmental elements contribute to AGA, resulting in an upregulation of perifollicular 5-alpha reductase (Rogers and Avram, 2008). This enzyme converts testosterone to dihydrotestosterone, binding to androgen receptors and activating genes that transform healthy terminal follicles into vellus-like hairs in androgen-dependent scalp regions, including the central, frontal and parietal areas.1,2
Hair follicle miniaturization serves as the histological hallmark and once miniaturization and detachment occur, hair loss becomes irreversible. The psychological and emotional impact of hair loss, affecting quality of life, underscores the need for safe and effective treatment modalities in dermatology practice. Current options such as minoxidil, finasteride, spironolactone, nutritional supplements, lowlevel light therapy and hair transplantation surgery exist. While topical minoxidil and oral finasteride are FDA-approved, their clinical efficacy can vary, prompting exploration of alternative treatments 1,2
Topical minoxidil, available as a solution or foam, is generally well-tolerated, with minor adverse effects. Finasteride, acting as a selective type II 5 alpha reductase antagonist, reduces dihydrotestosterone levels, the key contributor to MAA. Sexual side effects are infrequent, often resolving without discontinuation. Dutasteride, inhibiting both type I and type II 5 alpha reductase, might surpass finasteride in efficacy but carries a higher risk of sexual side effects. Combining medications with varied mechanisms enhances efficacy. Emerging treatments like topical antiandrogens, prostaglandin analogues, antifungals, growth factors and laser therapies lack conclusive research on efficacy and safety. Hair transplantation, involving grafting from the occipital scalp to the bald areas, offers
a reliable cosmetic solution with graft survival exceeding 90%. A combination of these therapeutic approaches provides a comprehensive arsenal for managing MAA, allowing for favourable cosmetic outcomes.
Platelet-rich plasma (PRP) has gained popularity for AGA due to its autologous nature, minimal invasiveness, lack of major side effects and cost-effectiveness compared to surgical options. PRP involves the concentration of platelets in plasma (usually > 1,000,000 platelets/μL or 2-7 times the native concentration of whole blood) (Marx, 2001).1 Its autologous origin and minimally invasive collection mitigate infection and immune rejection risks. As an evolving treatment avenue, PRP shows promise in addressing the challenges posed by female pattern hair loss, providing a potential alternative or adjunct to existing therapies.1,2
Case Study
A 30 years old male was presented to our clinic with the hair loss problem. Insidious onset with gradually progression of hair loss is seen. After making clinical examination the hair thinning and patterned hair loss particularly on specific region of scalp was seen. Patient had no other medical history nor was the patient on any other medication. Results of laboratory investigations (including complete blood cell counts, basal thyroid-stimulating hormone etc.) were within normal limits. We diagnosed the patient with androgenetic alopecia or patterned hair loss. PRP was suggested after considering all the factors. The treatment regime was concluded in 4 sessions for 4 month. The development of new hairs, thickening of hairs was seen after 2 sessions of treatment. The bladness started to recover and regrowth of hair was seen.
Figure 1: Hair thinning and hair loss on scalp
Diagnosis
Diagnosing hair loss involves a comprehensive evaluation of the patient's medical history, physical examination and sometimes additional tests or procedures. Gathering information about symptoms, medical history, family history of hair loss, any underlying medical conditions, recent illnesses, medications and lifestyle factors that may contribute to hair loss provides accurate and detailed information that will help in making an accurate diagnosis. A thorough examination of the scalp, hair and affected areas is conducted to assess the pattern and extent of hair loss, the quality of the remaining hair, the presence of inflammation or scarring and any other relevant findings. Dermo scopy is a noninvasive technique that allows magnified visualization of the scalp and hair follicles. It can provide valuable information about the hair shafts, scalp condition and follicular activity, aiding in the diagnosis of various hair disorders. Depending on the suspected cause of hair loss, blood tests may be recommended to check for specific medical conditions that can contribute to hair loss, such as thyroid disorders, hormonal imbalances, nutritional deficiencies (e.g., iron, vitamin D), autoimmune diseases or infections. In some cases, a small sample of the scalp may be taken for a biopsy to examine the hair follicles under a microscope. This can help differentiate between different types of hair loss and identify any underlying inflammatory
or scarring processes. If necessary, additional tests may be performed, such as a fungal culture to check for fungal infections, a hair pull analysis to assess the proportion of hairs in different growth phases, or a tricho gram to evaluate the hair cycle and density.3,4,5
Our case presented with diffuse thinning in vertex region with visible scalp, on dermo scopy, diameter variability exceeded 30%, with increased gap which supported our diagnosis of andro gentic alopecia.
Treatment
Current therapeutic strategies for androgenic alopecia primarily focus on promoting cellular proliferation and differentiation during the hair cycle. Some of the common treatment options includes, minoxidil a topical medication, is available over-the-counter and is applied directly to the scalp. It is thought to promote hair growth by prolonging the anagen phase and increasing blood flow to the hair follicles. A oral medication finasteride is available by prescription and is primarily used in men. It works by inhibiting the conversion of testosterone to dihydrotes tosterone (DHT), a hormone that is believed to contribute to hair loss. Sometimes hair transplant surgery can be performed were the hair follicles from areas of the scalp with healthy hair growth (typically the back or sides of the head) are transplanted to the balding areas. This can result in a natural-looking restoration of hair. Low-level laser therapy,
also known as red light therapy, involves using red light wavelengths to stimulate hair growth and improve the health of hair follicles.6
In addition to minoxidil and finasteride, which are FDAapproved drugs for hair loss treatment, there has been increasing interest in the potential use of platelet-rich plasma (PRP) for stimulating hair growth. PRP is derived from a person's own blood and contains a concentrated amount of platelets that release various growth factors and proteins. PRP has been suggested to have antia poptotic effects, meaning it can prevent cell death, which may contribute to its ability to stimulate hair growth. The activation of antia poptotic regulators such as the Bcl-2 protein and Akt signaling pathways by PRP can help prolong the survival of dermal papilla cells, which are important for hair follicle function. PRP treatment has also been associated with the upregulation of FGF-7/Bcatenin signaling pathways. This can potentially stimulate hair growth by promoting the differentiation of follicular stem cells and prolonging the anagen (growth) phase of the hair cycle. Furthermore, PRP has been shown to increase the levels of vascular endothelial growth factor (VEGF) and platelet- derived growth factor (PDGF). These growth factors have angiogenic potential, meaning they can promote the formation of new blood vessels. As a result, PRP may enhance the perifollicular vascular plexus, which can
provide improved blood flow to the hair follicles and support hair growth. The use of PRP for hair loss treatment may vary among individual patients and consulting with a medical professional experienced in hair restoration can help determine its suitability for specific cases. 6,7,8,9,10,11,12,13,14,15
The concentration of platelets in platelet-rich plasma (PRP) is an important factor that can influence its effectiveness in promoting hair growth. It has been observed that higher platelet concentrations tend to have a greater impact on hair density, follicle diameter and terminal hair density compared to lower platelet concentrations. The growth factors present in PRP, which are released by platelets, play a crucial role in stimulating hair growth and improving the function of hair follicles. One of the mechanisms by which PRP promotes hair growth is by activating the WNT/BCatenin signaling pathway. In androgenetic alopecia (AGA), dihydrote stosterone (DHT) can suppress the canonical WNT signaling in dermal papilla cells, leading to defective hair growth and disruption of the hair cycle. PRP therapy has been shown to counteract this effect by activating the WNT/B-Catenin signaling pathway. This activation leads to the proliferation and differentiation of hair follicle cells, triggering the growth of new hair and promoting the initiation of a new hair cycle. By providing a concentrated source of platelets and growth factors to the affected area,
PRP therapy aims to restore the balance and functionality of the hair follicles, improving hair growth and overall hair health.2
Discussion
In androgenic alopecia, the hair follicles undergo a process called miniaturization, in which the terminal (thick, pigmented) hairs gradually become thinner and shorter, eventually becoming vellus (fine, nonpigmented) hairs. Additionally, the anagen phase of the hair growth cycle, which is the active phase of hair growth, becomes shortened, leading to reduced hair density. Platelet-rich plasma (PRP) is autologous preparation of plasma that contains higher concentrations of platelets compared to those found in peripheral blood. Initially, PRP was used as a transfusion product to treat thrombocytopenia, a condition characterized by low platelet counts. However, it has since been discovered that PRP contains numerous growth factors and cytokines that can promote wound healing and tissue regeneration, leading to its expanded use in various medical fields, including sports medicine, regenerative medicine and aesthetic medicine. In recent years, PRP has gained attention and been extensively studied to have positive effects on hair regrowth and is being used as a therapeutic option for conditions like androgenetic alopecia, alopecia areata and female pattern hair loss. It is believed that the growth factors and cytokines present in PRP play a role in promoting
the proliferation and differentiation of hair follicle cells, stimulating the hair growth cycle and improving the overall condition of the scalp. Additionally, PRP's regenerative properties may help improve the blood supply to the hair follicles, enhancing their function and promoting hair growth. Adverse events associated with PRP therapy for hair loss are generally rare and mild, but it is still important to discuss potential risks and benefits with a qualified healthcare professional before considering treatment. Traditionally, PRP has been used in periodontal therapy, maxillofacial surgery, orthopedics and sports medicine. However, it has recently gained attention in dermatology for its role in treating acne scars, wound healing, fat grafting and hair regrowth. Research has shown that PRP can promote the proliferation of adipose precursor cells, wound repair, cellular differentiation and angiogenesis, highlighting its beneficial effects. The principle behind PRP treatment is to enrich the platelets by centrifugation, resulting in a higher concentration of platelets compared to RBCs. The high level of growth factors and cytokines in PRP is believed to facilitate tissue rejuvenation and healing. A platelet concentration of approximately 1 million platelets/μl, which is around five times the normal concentration, has been shown to be effective in tissue repair. While platelets are commonly known for their role in hemostasis, they
also contain a vast reservoir of proteins. When secreted, these proteins act on various targets, including stem cells, fibroblasts, osteoblasts, endothelial cells and epithelial cells. The release of these factors begins shortly after platelet activation. In addition to platelets and their secreted factors, PRP also contains other active components such as fibrinogen and leukocytes. It is believed that the therapeutic benefits of PRP stem not only from platelets but from the combination of constituents and growth factors present in PRP.2,16
Conclusion
Platelet-rich plasma (PRP) therapy has gained popularity as a potential therapeutic option for various types of hair loss, including androgenetic alopecia (AGA) and chronic telogen effluvium. PRP contains a concentrated form of platelets and growth factors obtained from the patient's own blood, which are believed to promote hair growth and improve hair follicle function. For androgenetic alopecia and female pattern hair loss, PRP can be used as a monotherapy or in combination with conventional treatments such as topical medications (e.g., minoxidil) or oral medications (e.g., finasteride). It is thought that PRP enhances the effectiveness of these treatments by providing a rich source of growth factors to the hair follicles, stimulating hair growth and improving the overall condition of the scalp. Additionally, PRP can be used as an adjuvant therapy to complement hair
transplantation procedures. By injecting PRP into the scalp during or after transplantation, it is believed to enhance the survival and growth of the transplanted hair follicles, leading to improved results. Furthermore, PRP has shown promise as a safe and effective treatment for alopecia, PRP's growth factors and antiinflammatory properties are believed to have a beneficial effect on the immune system, helping to promote hair regrowth in individuals with alopecia areata.
References
1. Stevens, J, and S Khetarpal. “Plateletrich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol.” International journal of women's dermatology vol. 5,1 46-51. 21 Sep. 2018, doi:10.1016/j. ijwd.2018.08.004
2. Khatu, Swapna S et al. “Plateletrich plasma in androgenic alopecia: myth or an effective tool.” Journal of cutaneous and aesthetic surgery vol. 7,2 (2014): 107-10. doi:10.4103/09742077.138352
3. Mounsey AL, Reed SW. Diagnosing and treating hair loss. Am Fam Physician. 2009 Aug 15;80(4):356-62. PMID: 19678603.
5. Singh, Sukhbir, and Kumaresan Muthuvel. “Practical Approach to Hair Loss Diagnosis.” Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India vol. 54,4 399-403. 27 Dec. 2021, doi:10.1055/s-0041-1739240
6. Dhurat R, Sukesh M. Principles and methods of preparation of plateletrich plasma: A review and author's perspective. J Cutan Aesthet Surg. 2014;7(4):189-197.
7. Giordano S, Romeo M, Lankinen P. Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol. Dermatol Ther (Heidelb). 2017;7(1):1-13.
8. Shin H, Ryu H, Kwon O, et al. The beneficial effects of minoxidil on human hair follicle growth in vitro. J Dermatol Sci. 2007;45(2):106-108.
9. Li Y, Xu B, Xu M, et al. Effects of minoxidil on proliferation and apoptosis in dermal papilla cells of human hair follicle. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014;39(2):117-122.
10. Itami S, Kurata S, Sonoda T, et al. Finasteride-induced apoptosis of cultured human dermal papilla cells. J Invest Dermatol. 1995;105(3):380-384.
11. Kim WS, Kim HJ, Kim JY, et al. The effect of topical minoxidil on follicular apoptosis in androgenetic alopecia. Br J Dermatol. 2004;150(1):186-194.
12. Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000;43(5 Pt 1):768-776.
13. Uebel CO, da Silva JB, Cantarelli D, et al. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg. 2006;118(6):14581466; discussion 1467-1458.
14. Zhang N, Dou C, Li Z, et al. Plateletrich plasma (PRP) improves fat grafting outcomes by promoting adipocyte survival and angiogenesis. Lipids Health Dis. 2018;17(1):166.
15. Gentile P, Garcovich S. Advances in regenerative stem cell therapy in androgenic alopecia and hair loss: Wnt pathway, growth-factor, and mesenchymal stem cell signaling impact analysis on cell growth and hair follicle development. Cells. 2019;8(5):466.
16. Jessica Cervantes, ET AL ; Effectiveness of Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature. Skin Appendage Disord 16 January 2018; 4 (1): 1–11. https:// doi.org/10.1159/000477671
PCOS: Laser, Light Therapy Helpful for Hirsutism
In patients with polycystic ovary syndrome (PCOS), laser and light therapies, alone or in combination with pharmacological agents, improve hirsutism and psychological well-being in women, according to the results of a systematic review.
Hirsutism, which affects 70%-80% of women with PCOS, is frequently marginalized as a cosmetic issue by healthcare providers, despite its significant psychological repercussions, including diminished self-esteem, reduced quality of life, and heightened depression. The 2023 international evidence-based PCOS guideline considers managing hirsutism a priority in women with PCOS. Researchers reviewed six studies (four randomized controlled trials and two cohort studies), which included 423 patients with PCOS who underwent laser or light-based hair reduction therapies, published through 2022. The studies evaluated the alexandrite laser, diode laser, and intense pulsed light (IPL) therapy, with and without pharmacological treatments. The main outcomes were hirsutism severity, psychological outcome, and adverse events.
Alexandrite laser (wavelength, 755 nm) showed effective hair reduction and improved patient satisfaction (one study); high-fluence treatment yielded better outcomes than low-fluence treatment (one study). Alexandrite laser 755 nm also showed longer hair-free intervals and greater hair reduction than IPL therapy at 650-1000 nm (one study). Combined IPL (600 nm) and metformin therapy improved hirsutism and hair count reduction compared with IPL alone, but with more side effects (one study). Diode laser treatments (810 nm) with combined oral contraceptives improved hirsutism and related quality of life measures compared with diode laser alone or with metformin (one study). Comparing two diode lasers (wavelengths, 810 nm), low-fluence, high repetition laser showed superior hair width reduction and lower pain scores than high fluence, low-repetition laser (one study).
Laser and light treatments alone or combined with other treatments have demonstrated “encouraging results in reducing hirsutism severity, enhancing psychological well-being, and improving overall quality of life for affected individuals,” the researcher wrote, noting that additional high-quality trials evaluating these treatments, which include more patients with different skin tones, are needed.
Recent Evidence for Home Phototherapy Benefits May Improve Access for Patients with Psoriasis
Supporters of home phototherapy for patients with plaque and guttate psoriasis had plenty to cheer about at the annual meeting of the American Academy of Dermatology (AAD) in March. The presented results from the LITE study, a trial that tested the hypothesis that narrowband ultraviolet B phototherapy of psoriasis at home is noninferior to office treatment, based on outcomes that matter to patients, clinicians, and payers. While smaller studies have drawn similar conclusions, LITE was the largest trial of its kind to show what many dermatologists have suspected for years: Home phototherapy can be an effective first-line treatment for patients with moderate to severe psoriasis. The co-primary outcomes in the LITE study were a Physician’s Global Assessment (PGA) score of 0/1 (clear, almost clear) and a Dermatology Life Quality Index (DLQI) score of 5 or less (small, no effect on health-related quality of life).
The researchers at 42 sites enrolled 783 patients aged 12 years and older who had plaque or guttate psoriasis and were candidates for phototherapy at home or in an office setting. Following 12 weeks of treatment, 25.6% of patients in the office-based phototherapy group achieved a PGA score of 0/1 compared with 32.8% of patients in the home-based phototherapy group (P > .0001 for noninferiority, non-response imputation for missing data). Similarly, 33.6% of patients in the office-based phototherapy group achieved a DLQI score of 5 or less compared with 52.4% of patients in the homebased phototherapy group (P > .0001 for noninferiority, non-response imputation for missing data).
Clinicians and patients can learn about the efficacy and safety of phototherapy for psoriasis, including home-based options, on the NPF’s web site and by reading the 2019 joint AAD-NPF guidelines. Shared decision-making is key. “When a patient comes in, We will discuss what their treatment options are and [we] will decide upon a course of action based on their unique needs and preferences [and] if it’s medically appropriate, meaning they have the type of psoriasis likely to respond to phototherapy. A patient with psoriasis mainly on the fingernails or genitals “is not a good candidate for phototherapy. If it’s on the trunk or extremities, that patient would be a good candidate.”Home phototherapy candidates also must be willing and able to operate a machine and have dedicated space in their dwelling for it (most units are about the size of a door). Patients also have to be reliable, follow directions, and come back in person for follow-up appointments “so we can assess their response to treatment and fine-tune things as necessary and make sure they’re not developing any skin damage,” researcher said.
Lidocaine & Prilocaine Cream
Acid (AHA) 6%
Lactic Acid(BHA) 2%
Retinyl Palmitate 0 001% Ceramide-2.
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Glycolic
Yellow Peel……. A Boon or Bane?
Dr. Fariya Rasheed MD, DVL (OSMANIA)
Consultant Dermatologist
Dr. Fariya Rasheed's Skin, Laser and Hair Clinic
Hyderabad, India
Introduction
In the quest for flawless skin, hyperpigmentation stands as a formidable foe, affecting individuals of all ages and skin types. Conditions such as melasma, post-acne pigmentation, photo melanosis and post-inflammatory hyperpigmentation pose significant challenges for both patients and dermatologists alike. However, amidst the myriad of treatments available, a promising solution has emerged: the Yellow Peel. This article explores the efficacy and benefits of yellow peel in addressing various forms of hyperpigmentation.1,2,3
Understanding Melasma: Melasma, a stubborn dermatosis, often poses a significant challenge in terms of treatment efficacy. It represents a chronic, acquired hyperpigmentation of the skin with a significant impact on quality of life. It is characterized by brown to gray-brown patches on the face, often occurs due to hormonal changes, sun exposure or genetic predisposition. Melasma poses a significant challenge due to its chronic nature and propensity for recurrence.
Despite being challenging to treat, it is essential to adopt a multimodal approach to its management. While various approaches exist, chemical peeling stands out as a viable option for managing melasma of different types and durations. Counseling patients about the chronic nature of the condition, emphasizing the importance of photoprotection and addressing the role of hormones in disease persistence are crucial steps before initiating therapeutic interventions. Despite the best interventions, improvement is often limited by recurrences, highlighting the ongoing challenge of managing melasma effectively. On the other hand, post-acne pigmentation, photo melanosis and post-inflammatory hyperpigmentation stem from inflammation, injury or excessive melanin production triggered by UV radiation.1,2,3,4,5,6,7
Understanding Post-Acne Pigmentation: Acne not only wreaks havoc during its active phase but also leaves behind unsightly pigmentation marks. Post-acne pigmentation,
often referred to as acne scars, can significantly impact an individual's self-esteem and quality of life. Post-acne pigmentation occurs as a result of inflammation and trauma to the skin during acne breakouts. This leads to the overproduction of melanin, the pigment responsible for skin coloration, resulting in dark spots or patches on the skin's surface. While post-inflammatory hyperpigmentation (PIH) typically fades over time, some cases may persist, requiring intervention to achieve optimal resolution.8,9
Understanding Photo Melanosis: Photo melanosis, also known as sun-induced hyperpigmentation, occurs when melanocytes, the cells responsible for producing melanin, become overactive in response to ultraviolet (UV) radiation from the sun. Excessive sun exposure can lead to photo melanosis, characterized by diffuse hyperpigmentation and uneven skin tone. While sun protection remains paramount. This excessive melanin production leads to the development of dark spots, patches and uneven skin tone, commonly observed on sun-exposed areas such as the face, neck and hands.10,11
Understanding PostInflammatory
Hyperpigmentation: Post-inflammatory hyperpigmentation (PIH) is a common dermatological concern characterized by the darkening of the skin
following inflammation or injury. Acne, eczema and skin trauma are among the leading causes of PIH, often leaving individuals with persistent discoloration and uneven skin tone. Post-inflammatory hyperpigmentation occurs when melanocytes, the pigment-producing cells in the skin, become overactive in response to inflammation or injury. This excess melanin production leads to the formation of dark patches or spots, which can persist long after the initial inflammatory episode has resolved. PIH can affect individuals of all skin types and ethnicities, posing significant cosmetic concerns and impacting selfesteem and confidence.12,13
This article aims to provide a comprehensive overview of yellow peel treatment for post-inflammatory hyperpigmentation, postacne pigmentation, photo melanosis including its mechanism of action, benefits, procedure and potential outcomes.
Yellow peel (Active Ingredients and its Mechanism of action)14,15,16,17
Yellow peel is a highly effective skincare procedure designed to exfoliate old skin cells and stimulate the regeneration of new cells, ultimately enhancing the appearance of the skin. This treatment utilizes a combination of compounds that may vary depending on the brand and composition of the peel. However, several key substances or active Ingredients are commonly
found in yellow peels:
1. Trichloroacetic Acid (TCA): TCA is often used in medium-depth chemical peels to target various skin concerns. This acid, derived from acetic acid found in vinegar, helps to exfoliate the skin and improve its texture.
2. Retinoic Acid (Vitamin A): Retinoic acid, a potent form of Vitamin A, is known for its antioxidant properties and its ability to improve skin texture and reduce signs of aging, reduce the appearance of fine lines and wrinkles and promote collagen production. It is renowned for their remarkable ability to enhance skin renewal and stimulate collagen production. It is frequently included in skincare products to promote cellular turnover and collagen production. It can also aid in exfoliation and unclogging pores, making it beneficial for acne-prone skin.
3. Beta-Hydroxy Acid (Salicylic Acid): Salicylic acid is a beta-hydroxy acid commonly used in skincare for its exfoliating and poreclearing properties. It helps to unclog pores, reduce inflammation and improve overall skin tone and texture. It penetrates deep into the pores to dissolve excess oil and dead skin cells. It is effective in treating acne and preventing future breakouts. Salicylic acid also has antiinflammatory properties, which can help reduce redness and irritation.
4. Lactic Acid: Lactic acid is an alpha-hydroxy acid that acts as a gentle exfoliant,
helping to remove dead skin cells and promote cell turnover. It is often used in chemical peels to improve skin texture, reduce the appearance of fine lines and wrinkles and even out skin tone.
5. Phenol: Phenol is a potent substance used in deep chemical peels to target more severe skin issues and remove layers of damaged skin. It can effectively address deep wrinkles, scars and hyperpigmentation, but it requires careful application and may involve a longer recovery time.
6. Phytic Acid 0.5%: Phytic acid is a natural antioxidant found in plant seeds. In skincare, it acts as a gentle exfoliant, helping to remove dead skin cells and promote cell turnover. Phytic acid also has skin-brightening properties and can help even out skin tone.
7. Arbutin 4%: Arbutin is a natural skin-lightening agent derived from bearberry, cranberry or blueberry plants. It inhibits tyrosinase, the enzyme responsible for melanin production, thereby reducing the appearance of hyperpigmentation and dark spots. Arbutin is considered a safer alternative to hydroquinone for skin lightening.
8. Kojic Acid 5%: Kojic acid is another skin-lightening ingredient derived from various fungi, such as koji fungus. Like arbutin, it inhibits tyrosinase activity, leading to a reduction in melanin production. Kojic acid is often used to treat
hyperpigmentation, age spots, and melasma.
Treatment
Yellow peel represents a progressive peel technique characterized by its customizable nature. The efficacy of the treatment varies depending on the number of applied layers, allowing for tailored solutions to individual skin concerns. Within hours post-treatment, Yellow peel induces microcirculation, enhances oxygen supply to the skin, and facilitates the delivery of nourishing substances, resulting in rejuvenated and revitalized skin.
• Efficacy in melasma: Traditional treatments often yield limited success and may cause adverse effects. However, studies have demonstrated the efficacy of yellow peel in managing melasma. By specifically targeting melanin without causing thermal damage, yellow peel offers a safe and efficient solution for reducing pigmentation and improving overall skin tone. Before delving into the specifics of yellow peel, it is crucial to grasp the underlying mechanisms of hyperpigmentation.17,18
• Combatting Post-Acne
Pigmentation: Post-acne pigmentation can persist long after the acne has healed. Despite various treatment options available, addressing post-acne pigmentation remains a challenge for many. Yellow peel treatment has emerged as a promising solution for improving postacne pigmentation, offering
effective results with minimal risks. Yellow peel presents a promising avenue for addressing post-acne pigmentation, its ability to break down melanin deposits and stimulate collagen production, resulting in smoother, more even-toned skin.18,19,20,21
• Revolutionizing ........... Treatment for Photo
Melanosis: Photo melanosis, characterized by the irregular and excessive accumulation of melanin in the skin due to prolonged sun exposure, poses a significant challenge for individuals seeking to achieve clear and radiant skin. While various treatments exist, yellow peel has emerged as a promising solution for addressing photo melanosis effectively. Yellow peel offers a complementary approach to managing photo melanosis. By selectively targeting melanin and promoting cellular turnover, yellow peel helps diminish the appearance of sun-induced pigmentation, restoring radiance to the skin.5,7,22
• Addressing PostInflammatory ....... Hyperpigmentation: .......: ......... Post-inflammatory hyperpigmentation (PIH) often arises as a consequence of trauma, acne or other skin conditions. Conventional treatments for PIH may yield inconsistent results and carry the risk of adverse reactions. In recent years, yellow peel has emerged as a promising solution for addressing PIH, offering a safe and effective means of achieving clearer, more evenly pigmented
skin. Yellow peel presents a gentler alternative, effectively reducing hyperpigmentation without causing significant downtime or discomfort. Its ability to modulate melanin production and promote skin rejuvenation makes it a valuable tool in the treatment armamentarium. Additionally, the yellow peel promotes collagen synthesis, leading to skin regeneration and rejuvenation. By targeting both the epidermis and dermis, yellow peel effectively addresses the underlying causes of PIH, resulting in clearer, more uniform skin.12,13
Procedure23
Yellow peel treatment is typically performed by a qualified dermatologist or skincare professional in a clinical setting. The procedure involves the following steps:
• Cleansing: The skin is cleansed thoroughly to remove any impurities, oil or makeup.
• Pre-peel preparation: A pre-peel solution may be applied to prepare the skin and optimize the effects of the peel.
• Application: The yellow peel solution is carefully applied to the affected areas of the skin using a brush or applicator.
• Neutralization: After a specified duration, the peel is neutralized using a neutralizing solution to halt the chemical reaction.
• Post-treatment care: Patients are provided with post-treatment instructions, including the use of sunscreen
and gentle skincare products to protect and nourish the skin during the healing process.
Yellow peel treatment for post-acne pigmentation can yield significant improvements in skin tone, texture and pigmentation. However, individual responses may vary and multiple treatment sessions may be necessary to achieve optimal results. Additionally, patients should be aware of potential side effects, including temporary redness, irritation and mild peeling, which are typically transient and resolve with time. It is essential for patients to follow their dermatologist's recommendations and adhere to a comprehensive skincare regimen to maintain the benefits of yellow peel treatment over time.
Potential Outcomes and Considerations
Yellow peel treatment offers a safe, effective, versatile and non-invasive solution for addressing post-inflammatory hyperpigmentation, photo melanosis, post-acne pigmentation and achieving clearer, more radiant skin, providing patients with noticeable improvements in skin tone and texture. By understanding the mechanism of action, benefits, procedure and potential outcomes of yellow peel treatment, individuals can make informed decisions about their skincare journey and take proactive steps towards achieving their desired complexion. With the guidance of a qualified healthcare professional, individuals can regain confidence in their skin and enjoy a more radiant complexion.12,17,24
Benefits and Advantages 25, 26
The yellow peel adds another layer of efficacy to the treatment for wide range of skin concerns. Furthermore, its compatibility with different skin types and minimal downtime make it a popular choice among individuals seeking visible and longlasting results.
1. Targeted Exfoliation: The chemical components of yellow peel penetrate the skin's layers, effectively removing dead skin cells and promoting the growth of new, healthy skin cells. It treatment effectively targets and removes hyperpigmented areas of the skin, revealing smoother, promoting the shedding of damaged cells and revealing fresh, evenly pigmented skin underneath.
2. Minimizing Scarring: Yellow peel treatment may help reduce the appearance of acne scars by promoting tissue regeneration and remodeling.
3. Lightening Hyperpigmentation: Yellow peel treatment targets melanin production. The exfoliating action of yellow peel helps to lighten dark spots and patches associated with post-acne pigmentation, photo melanosis and PIH restoring a more uniform complexion and reducing the appearance of discoloration.
4. Stimulating Collagen Production and cellular renewal: By promoting cellular turnover and collagen synthesis, yellow peel treatment rejuvenates the skin, accelerates the skin's natural healing process, leading to faster resolution of hyperpigmentation and improved skin texture, smoothness, firmness and overall appearance.
and revealing a brighter, more luminous complexion.
6. Minimizing Recurrence: Yellow peel treatment addresses the root causes of PIH, making it less likely for dark spots to reappear following inflammation or injury. With consistent treatment and proper skincare, individuals can maintain clearer, more even-toned skin in the long term.
7. Combatting Early Signs of Aging: One of the primary indications for the yellow peel is to combat the early signs of aging. As individuals age, the skin undergoes structural changes, resulting in the formation of wrinkles, fine lines and loss of elasticity. The yellow peel works by rejuvenating the skin at a cellular level, promoting collagen production, and smoothing out imperfections, thereby restoring a youthful appearance.
8. Correcting Existing Damage: In addition to preventing further aging,yellow peel excels in correcting existing skin damage. Whether it's suninduced hyperpigmentation, acne scars or melasma, this advanced treatment targets pigmentation irregularities and promotes even-toned skin. By stimulating cellular turnover and collagen synthesis, yellow peel helps fade dark spots, reduce scarring and improve overall skin texture.
Contraindications of Yellow Peel 27, 28
Some contraindications of yellow peel treatment include:
After Before
1. Pregnancy and Breastfeeding: Women who are pregnant or breastfeeding should avoid yellow peel treatments due to potential risks to the unborn child or nursing infant.
2. Skin Infections or Inflammation: Patients with active skin infections or inflammation should not undergo yellow peel treatment, as it may exacerbate the condition and lead to further complications.
3. Sunburn or Windburn: Patients with sunburn or windburn should wait until their skin has fully healed before undergoing yellow peel treatment to avoid aggravating irritation and discomfort.
4. Recent Facial Surgery: Patients should postpone yellow peel treatment until they have fully recovered from recent facial surgeries, as the procedure may interfere with the healing process and potentially cause complications.
5. Allergies: Individuals allergic to any components of the yellow peel solution should refrain from undergoing the treatment to prevent allergic reactions such as redness, swelling, itching, or even anaphylaxis in severe cases.
6. Dark Skin Tone: Yellow peel treatment should be approached with caution in patients with dark skin tones, as it may increase the risk of uneven pigmentation, scarring, and permanent discoloration.
7. Active Cold Sores or Herpes Simplex: Patients
with active cold sores or herpes simplex should avoid yellow peel treatment to prevent the spread of the virus and potential complications.
8. Medications: Certain medications, such as isotretinoin or other retinoids, can increase skin sensitivity and the risk of adverse reactions to yellow peel treatment. Patients taking such medications should consult with their healthcare provider before undergoing the procedure.
Discussion
In essence, a yellow peel, also known as a chemical peel, is a cosmetic procedure involving the application of a chemical solution to the skin to exfoliate and improve its overall appearance. The yellow peel procedure has emerged as a popular skincare treatment in recent years, harnessing the power of acid-based solutions to exfoliate the skin and promote cell renewal. Typically, acids sourced from fruits like papaya, pineapple or lemon are utilized in yellow peel treatments, offering a non-invasive approach to improving skin tone, texture and overall appearance. This chemical exfoliation procedure is known for its efficacy in addressing various skin concerns, including acne scars, fine lines, wrinkles, hyperpigmentation, sun damage, uneven skin tone, dull complexion, enlarged pores, oily skin and other skin imperfections.14,23,28
By eliminating dead skin cells and stimulating cell turnover, yellow peel treatments can
help rejuvenate the skin, leaving it looking brighter, smoother and more radiant. Hyperpigmentation poses a formidable challenge for individuals seeking clear, radiant skin. While various treatments exist, yellow peel stands out as a safe, effective solution for melasma, post-acne pigmentation, photo melanosis, and post-inflammatory hyperpigmentation. By harnessing the power of targeted light therapy, yellow peel offers hope to those grappling with pigmentation woes, helping them achieve a brighter, more even complexion with minimal risk and downtime. As dermatologists continue to refine and innovate, yellow peel holds immense promise in the realm of hyperpigmentation management, paving the way for renewed confidence and self-assurance.
One of the notable advantages of the yellow peel is its versatility, making it suitable for all skin types. However, individuals with oily or acneprone skin may particularly benefit from this procedure due to its ability to unclog pores and reduce excess oil production. Moreover, the yellow peel is also recommended for mature individuals looking to combat signs of aging. By promoting collagen production and improving skin elasticity, this treatment can help diminish the appearance of age-related skin concerns, resulting in a more youthful complexion. Overall, the yellow peel offers a gentle yet effective solution
for individuals seeking to enhance their skin's appearance and address specific dermatological issues. With its ability to deliver noticeable results without invasive measures, it has become a popular choice among skincare enthusiasts looking to achieve healthier, more radiant skin.
Overall, yellow peel cosmetic treatment offers a comprehensive solution for improving various skin concerns. It is a safe and effective procedure that can be tailored to meet the individual needs of each patient. However, it's essential to consult with a qualified practitioner before undergoing this procedure to ensure its safety and suitability for your skin. Adhering to proper aftercare guidelines is crucial for achieving optimal results and minimizing the risk of complications, as with any cosmetic treatment.14,23,28
Conclusion
In the quest for youthful, radiant skin, yellow peel emerges as a potent treatment option. By harnessing the synergistic benefits of retinoids and yellow peel technology, this innovative treatment offers a transformative experience for individuals looking to rejuvenate their complexion and correct various skin imperfections. Whether it's combating wrinkles, treating hyperpigmentation, or addressing acne, yellow peel delivers on its promise of smoother, more radiant skin, empowering individuals to age gracefully and confidently.
Yellow peel is recognized for its safety profile, making it suitable for addressing various skin concerns with minimal risk. Whether targeting hyperpigmentation, melasma, or acne scarring, yellow peel offers immediate brightening effects while ensuring a safe and effective treatment experience. Formulated in both mild and intense variants, yellow peel caters to diverse skin types, providing optimal results with minimal recovery time. With its proven efficacy, safety and versatility, yellow peel empowers individuals to achieve radiant, youthful skin and embark on a journey towards lasting beauty and confidence. This article aims to delve deeper into the mechanism, safety and efficacy of yellow peel, providing insights into its remarkable benefits and applications.
2. Garibyan L, Tuchayi SM. Melasma: What are the best treatments? July 11, 2022
3. Bowers J. “Managing melasma: Dermatologists discuss new understandings of the pathogenesis of melasma and emerging treatments.” Dermatol World. 2020;30(1):44-9.
4. Sarkar, Rashmi et al. “Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.” Indian journal of dermatology vol. 62,6 (2017): 558-577. doi:10.4103/ijd.IJD_489_17
5. Moolla S, Miller-Monthrope Y. Dermatology: how to manage facial hyperpigmentation in skin of colour.
6. Grimes PE, Callender VD, Dellavalle RP et al. Melasma: Management. Feb 2024.
7. Thawabteh AM, Jibreen A, Karaman D, Thawabteh A, Karaman R. Skin Pigmentation Types, Causes and Treatment-A Review. Molecules. 2023 Jun 18;28(12):4839. doi: 10.3390/ molecules28124839. PMID: 37375394; PMCID: PMC10304091.
8. Al-Qarqaz F, Bodoor K, Baba A, Al-Yousef A, Muhaidat J, Alshiyab D. Post-acne hyperpigmentation: Evaluation of risk factors and the use of artificial neural network as a predictive classifier. Dermatol Reports. 2021 Oct 6;13(3):8223. doi: 10.4081/ dr.2021.8223. PMID: 34880967; PMCID: PMC8611517.
9. Hazarika N, Archana M. The Psychosocial Impact of Acne Vulgaris. Indian J Dermatol. 2016 SepOct;61(5):515-20. doi: 10.4103/00195154.190102. PMID: 27688440; PMCID: PMC5029236.
10. Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008 MayJun;84(3):539-49. doi: 10.1111/j.17511097.2007.00226.x. PMID: 18435612; PMCID: PMC2671032.
11. Speeckaert, R., Van Gele, M., Speeckaert, M.M., Lambert, J. and van Geel, N. (2014), The biology of hyperpigmentation syndromes. Pigment Cell Melanoma Res., 27: 512-524. https://doi.org/10.1111/pcmr.12235
12. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010 Jul;3(7):20-31. PMID: 20725554; PMCID: PMC2921758.
13. Lawrence E, Al Aboud KM. Postinflammatory Hyperpigmentation. [Updated 2022 Oct 3]. In: StatPearls
Yellow Peel……. A Boon or Bane?
[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm. nih.gov/books/NBK559150/
14. Soleymani T, Lanoue J, Rahman Z. A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. J Clin Aesthet Dermatol. 2018 Aug;11(8):21-28. Epub 2018 Aug 1. PMID: 30214663; PMCID: PMC6122508.
15. Razi S, Bhardwaj V, Ouellette S, Khan S, Azadegan C, Boyd T, Rao B. Demystifying the mechanism of action of professional facial peeling: In-vivo visualization and quantification of changes in inflammation, melanin and collagen using Vivascope® and ConfoScan®. Dermatol Ther. 2022 Nov;35(11):e15846. doi: 10.1111/ dth.15846. Epub 2022 Oct 3. PMID: 36129212; PMCID: PMC9787425.
16. Mageruaan SE, Hancu G, Rusu A. A Comprehensive Bibliographic Review Concerning the Efficacy of Organic Acids for Chemical Peels Treating Acne Vulgaris. Molecules. 2023; 28(20):7219. https://doi.org/10.3390/ molecules28207219
17. Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B. Evidence and considerations in the application of chemical peels in skin disorders and aesthetic resurfacing. J Clin Aesthet Dermatol. 2010;3(7):32-43
18. Sarkar R, Bansal S, Garg VK. Chemical peels for melasma in darkskinned patients. J Cutan Aesthet Surg. 2012;5(4):247-253. doi:10.4103/09742077.104912
19. Sarkar R, Chugh S, Garg VK. Newer and upcoming therapies for melasma. Indian J Dermatol Venereol Leprol 2012;78:417-428
20. M.K. Trivedi, F.C. Yang, B.K. Cho. A review of laser and light therapy in melasma. International Journal of Women's Dermatology, Volume 3, Issue 1,2017, Pages 11-20, ISSN 2352-6475, https://doi.org/10.1016/j. ijwd.2017.01.004. (https://www.
21. Javaheri, S.M., Handa, S., Kaur, I. and Kumar, B. (2001), Safety and efficacy of glycolic acid facial peel in Indian women with melasma. International Journal of Dermatology, 40: 354-357. https://doi.org/10.1046/ j.1365-4362.2001.01149.x
22. Solano F. Photoprotection and Skin Pigmentation: Melanin-Related Molecules and Some Other New Agents Obtained from Natural Sources. Molecules. 2020; 25(7):1537. https:// doi.org/10.3390/molecules25071537
23. Samargandy S, Raggio BS. Chemical Peels for Skin Resurfacing. [Updated 2023 Oct 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm. nih.gov/books/NBK547752/
24. Dayal S, Sahu P, Sangal B, Sharma S. Role of chemical peels in postinflammatory hyperpigmentation: a comprehensive review. Pigment Int 2019;6:59-66.
25. Khunger N, Chanana C. A perspective on what’s new in chemical peels. CosmoDerma 2022;2:14.
26. Ayhan S, Baran CN, Yavuzer R, et al. Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face. Plast Reconstr Surg. 1998;102(4):1238-1246.
27. Trivedi MK, Kroumpouzos G, Murase JE. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Womens Dermatol. 2017;3(1):6-10. Published 2017 Feb 27. doi:10.1016/ j.ijwd.2017.01.005
28. Khunger N. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol 2008;74:5-12
Lips Reshaping with Dermal Fillers
Dr. Komal Jerath
MD (Dermatology)
Dermatologist, Cosmetologist and Trichologist
Komal Skin and Cosmetology Clinic
Amritsar, Punjab
Introduction
Lips play a significant role in creating a harmonious and aesthetically pleasing appearance of the face. They are considered to be a defining feature that can greatly influence the overall look of the face. Whether it is to add volume, improve symmetry or enhance the shape of the lips, the lip filler procedure is becoming increasingly popular as a way to achieve a more youthful and attractive appearance. However, as with any cosmetic procedure, it is important to choose a qualified and experienced practitioner to ensure that the outcome is both safe and satisfying. The anatomy of the lip region is crucial to understand when performing lip filler injections. The accurate knowledge of the different structures and their boundaries is essential to achieve a natural and aesthetically pleasing result. The upper and lower lips have specific landmarks and features that must be considered during the procedure, such as the Cupid's bow, the philtrum and the vermilion/ skin border. The practitioner must also be aware of the
underlying anatomy, such as the vessels, nerves and muscles, to minimize the risk of complications and ensure a safe and successful outcome. There are a number of reconstructive procedures available, including surgical and non-surgical options, but notes that non-surgical options are the most commonly used. Among the non-surgical procedures, hyaluronic acid-based dermal fillers are frequently used due to their multiple advantageous properties, such as being naturally occurring, non-immunogenic, having antioxidant and antiinflammatory effects and supporting tissue regeneration and wound-healing.1,2
The different techniques used for lip augmentation, including the use of hyaluronic acid fillers. The ideal lip proportion is 1:1.6, but this may vary in African and Asian patients. Lip filler injections are a cosmetic procedure to enhance the appearance of the lips by adding volume and shape using fillers, such as hyaluronic acid (HA). The procedure involves injecting the filler into specific areas of
the lips using either a needle or a cannula. The choice of needle or cannula depends on various factors, such as the desired outcome, the patient's anatomy and the practitioner's expertise. The objective of the procedure is to achieve a natural-looking result with balanced and symmetrical lips. In order to achieve the best results, the procedure should be performed by a trained and experienced practitioner who has a good understanding of anatomy and the principles of injecting fillers.3,4
Lip filler procedures have been widely used and widely researched and the most common method is the injection of hyaluronic acid or similar dermal fillers into the lips to add volume, shape or enhance their natural contours. The fillers used are usually made of hyaluronic acid, a naturally occurring substance in the body. The procedure is minimally invasive and results can last several months to a year and the procedure can be repeated as needed to maintain the desired effect. There may be some side effects, such as swelling, bruising or discomfort, but these are usually temporary. Injecting hyaluronic acid filler into the lips can enhance their volume and shape, making them appear fuller, poutier and more youthful. The goal of lip augmentation with filler is to create a natural-looking result that enhances the patient's facial aesthetics while maintaining the proper lip proportions. The ideal ratio of lip width to height may vary based on individual anatomy
and cultural preferences and it's important to take these factors into consideration when performing lip augmentation.4,5
It's also important to note that lip augmentation with filler is not a permanent solution and repeat treatments may be necessary to maintain the desired result. Patients should choose a qualified and experienced injector who can provide a thorough consultation and evaluation to ensure safe and effective lip augmentation.
Case Presentations
Case 1
A 30 year old female visited our clinic. She had slight asymmetry in the shape of her upper lips. For rectification of this, 1 ml syringe of hyaluronic acid filler with lidocaine was used for this correction . These HA fillers of low G prime give very soft, natural and voluminous look. Lidocaine in the syringe helped to make the procedure more bearable for the patient.
As all the syringes of Hyaluronic acid fillers come in 1 ml, out of that 0.2 ml volume was used to correct upper lip asymmetry on the weaker side of upper lip . 0.1ml was given in the normal side of upper lip and 0.3 ml in the entire lower lip to give the desired look of fuller and voluminous lips to the patient.
The remaining 0.2ml was given in the maroinette area (melomental folds) 0.1 ml on each side to lift angle of lips and give the patient more youthful look.
Before treatment
Case 2
After treatment
A 30 year old female presented to our clinic with slight asymmetry in right side of upper lip which was found to be more pronounced on smiling. Upon further discussion it was found that she was not suffering from any significant medical history or any other prominent medical conditions. Additionally she was also set to have her wedding one month later.
Correction of lip asymmetry was done using 0.2 ml of Hyaluronic acid gel 23mg/ml filler from a 1 ml syringe. 0.2 ml in the lip was used solely for upper lip asymmetry correction as she did not want any other treatment corrections on lip.
Figure 1: Lip filler for thin upper lip correction
Lips Reshaping with Dermal Fillers
Since the patient also had presence of acne scars and the same G prime molecule could be used for both the indications the remaining was injected in areas of her acne scars. There was slight oedema post treatment which settled later. Before and after treatment pictures were clicked and compared. The patient achieved very good result for both lip asymmetry and scne scars.
Before treatment
Treatment
After treatment
Hyaluronic acid dermal fillers have been used for wrinkles, nasolabial folds, marionette lines, pre-jowl sulcus, lips augmentation, fine lines around the mouth, under the eyes, cheek augmentation, earlobes and volume loss on the back of hands since ages. Lip augmentation can be a safe and effective way to enhance the appearance of the lips, but it is important to carefully consider the potential benefits and risks before undergoing treatment.6
Main benefits of lip fillers include, addition of volume to thin or uneven lips, enhancement in lip shape and contour, improvement of symmetry of the lips, correction of age-related volume loss. It is helpful in creation of a more youthful and defined lip appearance. This procedure is non-surgical as well as minimally invasive, it’s also less time consuming and easy with minimal downtime and additionally it is easily reversible if desired.6
Lip fillers come with some potential risks and side effects, such as, swelling and bruising can occur after the procedure and typically resolve within a few days to a week, some individuals may experience pain, tenderness or itching at the injection site also, at times uneven or asymmetrical results may occur and may require further treatments to correct. Although a rare occurrence is infection as in any other injectable procedure, allergic reaction to the filler material and necrosis or tissue death due to filler injection into the vessel.6
Dermal fillers can be used for treatment of skin laxity (loose) and loss of skin volume that can be caused by loss of hyaluronic acid or collagen. It may be seen that in such cases skin becomes thinner, it loses its elasticity and starts to sag.7
Hyaluronic acid dermal filler is one of the temporary dermal fillers. Hyaluronic acid occurs naturally throughout the body and the highest concentrations are in the joints, eyes and skin. In the skin hyaluronic acid attracts water, which allows the skin to become more hydrated and voluminous. As we age, the hyaluronic acid depletes or gets degraded and skin in our face begins to thin. The loss of volume may lead to either sagging or a sunken appearance of the face, wrinkles, fine lines, folds and thin lips.7
The U.S. FDA has approved dermal fillers for use in adults over the age of 21 for specific uses.8
* Absorbable also known as temporary fillers like HA are approved for moderate to severe facial wrinkles and skin folds, such as nasolabial folds and perioral lines.
* Augmentation or increase in volume of lips, cheeks, chin and back of the hand.
* The restoration and correction of signs of facial fat loss or facial lipoatrophy in people with human immunodeficiency virus (HIV).
* Correction of contour deficiencies, like wrinkles and acne scars.
Discussion
Lip augmentation is a cosmetic procedure that can be helpful in enhancing the appearance of the lips. This can be done using various techniques, like dermal fillers, fat transfer, lip implants and lip lift. Lip filler is a cosmetic
Figure 2: Lip filler for right side of upper lip
procedure and the fillers used are usually made of hyaluronic acid, a naturally occurring substance in the body or synthetic materials that mimic its effects. The treatment is performed by making use of a fine needle or cannula. The major aim is to create a natural-looking improvement to the shape and size of the lips, minus any noticeable changes to their movement or sensation. The effects of the treatment are not permanent and may last anywhere from several months to over a year, this depends on the type of filler used and the patient's skin metabolism. Lip fillers offer a non-surgical and less invasive way to enhance the appearance of the lips. Hyaluronic acid for lip augmentation has been almost quite safe and well tolerated. The safety assessments for lip augmentation can be defined based on a set of outcomes, including normal lip texture, firmness and symmetry, preserving the natural movements, function and sensation of the lips and no mass formation seen in the treated site.1,3,5,9
The use of lip fillers is gaining high popularity, especially among younger patients who aim to achieve a more youthful, pouty and attractive lip shape. The goal of lip augmentation with filler mainly depends on individual’s personal preferences and goals. Older women in general seek rejuvenation, while millennial patients tend to ask for "Russian lips" which is a vertical struts injection along the complete region
of the lip that could possibly lead to complications such as ischemia, tissue necrosis and visual loss. To reduce these risks to minimal, it is crucial for clinicians to have a thorough understanding of anatomy, lip zones, filler properties and safe injection techniques. The newer modified technique uses a larger bore cannula for achieving a lip eversion, increased vermillion height and a redrawn cupid's bow, with a lower risk of vascular occlusion and other such complications.1,5
Further studies on this can be helpful to confirm the safety and efficacy of this technique. Lip asymmetry can be rectified with filler injections by adding volume to the thinner side of the lips for achievement of a more balanced and symmetrical appearance. The injector will use their expertise to decide the amount and placement of filler needed to achieve the results desired, taking into consideration the individual's anatomy and goals. Various injection techniques can be used for lip filler treatments, such as, straight needle technique, cannula technique, serial puncture technique and vermilion border technique or combination of these techniques may also be used for a more natural looking result.1,5
The selection of technique will depend on the specific goals of the individual and the injector's professional judgement. Major benefits of lip fillers that can be beneficial in making an individual’s facial profile more appealing and
aesthetically pleasing are; they can give natural fullness, they enhance the appearance, they have little to no side effect also lip filler is a versatile procedure it can be used in several ways to correct the lip concerns, such as reducing the marionette lines, providing added definition to the cupid's bow, bringing more volume to the upper lip to the nose and lower the impact of perioral lines. It's also essential to understand that not all lip shapes and augmentations are suitable for every patient and a thorough consultation and evaluation is necessary to ensure a natural-looking outcome that enhances the patient's overall facial aesthetics.5,6
Conclusion
Dermal fillers have become an essential tool in the aesthetic industry, with an increase in demand for minimally invasive techniques to address the signs of aging. Their versatility and ability to restore volume and contour the face has made them the second most popular cosmetic procedure globally. As evolution occurs in the field of aesthetics, similarly the understanding and use of dermal fillers evolves. They are also considered as smart implants and are used in regenerative medicine and their use in medical aesthetics is being increasingly explored in recent times. With the advancement of cadaveric studies and safe injection practices, dermal fillers have now become safer and more predictable in their outcomes. The latest science supports the use of safer
Lips Reshaping with Dermal Fillers
materials which come with biostimulatory properties, standardized techniques and new methods to increase the clinical longevity of dermal fillers.
To make sure that lip fillers are safe and effective a thorough consultation and evaluation to determine the best approach for patient’s individual needs and goals is necessary. It is also important to select a high-quality, FDA-approved filler product that has been tested for safety and efficacy. Hyaluronic acid-based fillers are the very commonly used and are known for their safety and effectiveness. During the procedure, the injector should take good care to avoid injecting the filler into blood vessels, as this can lead to necrosis or loss of blood flow in the tissue. They should also monitor for occurrence of any adverse reactions or side effects and be prepared to manage them if necessary.
Overall, with proper precaution and attention, lip fillers can be a safe and effective way to enhance the appearance of the lips and achieve the desired results.
References
1. Luthra A. Shaping Lips with Fillers. J Cutan Aesthet Surg. 2015 Jul-Sep;8(3):139-42. doi: 10.4103/0974-2077.167269. PMID: 26644736; PMCID: PMC4645142.
2. Penna, V., Fricke, A., Iblher, N., Eisenhardt, S. U., & Stark, G. B. (2015). The attractive lip: A photomorphometric analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 68(7), 920–929. doi:10.1016/j.bjps.2015.03.013
3. Ren, H., Chen, X., & Zhang, Y. (2020). Correlation between facial attractiveness and facial components assessed by laypersons and orthodontists. Journal of Dental Sciences. doi:10.1016/j.jds.2020.07.012
4. Kar M, Muluk NB, Bafaqeeh SA, Cingi C. Is it possible to define the ideal lips? Acta Otorhinolaryngol Ital. 2018 Feb;38(1):67-72. doi: 10.14639/0392-100X-1511. PMID: 29756617; PMCID: PMC5952987.
5. Keramidas E, Rodopoulou S, Gavala MI. A Safe and Effective Lip Augmentation Method: The Stepby-Step (Phi) Technique. Plast Reconstr Surg Glob Open. 2021 Feb 2;9(2):e3332. doi: 10.1097/ GOX.0000000000003332. PMID: 33680634; PMCID: PMC7928943.
6. Lipko-Godlewska, Sylwia et al. “Whole-Face Approach with Hyaluronic Acid Fillers.” Clinical, cosmetic and investigational dermatology vol. 14 169-178. 17 Feb. 2021, doi:10.2147/CCID. S292501
7. Brandt, Fredric S, and Alex Cazzaniga. “Hyaluronic acid gel fillers in the management of facial aging.” Clinical interventions in aging vol. 3,1 (2008): 153-9. doi:10.2147/ cia.s2135
8. Bukhari, S. N. A., Roswandi, N. L., Waqas, M., Habib, H., Hussain, F., Khan, S., … Hussain, Z. (2018). Hyaluronic acid, a promising skin rejuvenating biomedicine: A review of recent updates and pre-clinical and clinical investigations on cosmetic and nutricosmetic effects. International Journal of Biological Macromolecules. doi:10.1016/j. ijbiomac.2018.09.18
9. Fakhari A, Berkland C. Applications and emerging trends of hyaluronic acid in tissue engineering, as a dermal filler and in osteoarthritis treatment. Acta Biomater. 2013 Jul;9(7):7081-92. doi: 10.1016/j. actbio.2013.03.005. Epub 2013 Mar 15. PMID: 23507088; PMCID:
Dapsone Gel 5%
O.M.C, Mineral Oil,Vitmin E, Benzophenone-3 Squalene, Kokum Butter & Shea Butter Butter
