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combining Laser treatment and Plasma injection for best skin tightening and scar removal results

combining Laser treatment and Plasma injection for best skin tightening and scar removal results

 

Introduction

Platelet-rich plasma (PRP, Vampire facial) which contains large amounts of growth factors has been tried to enhance the therapeutic efficacy of laser treatment for acne scar and wrinkle removal and skin tightening with the unknown underlying mechanism. Platelet-rich plasma (PRP, Vampire facial) is generated from autologous blood and consists of highly concentrated platelets which contain large amounts of various growth factors and cytokines which play key roles in tissue repair. Additionally, platelets can also induce the synthesis of various growth factors which promote tissue regeneration. PRP was demonstrated to accelerate epithelization and reduce inflammation after wounding in rabbits and has been suggested as a supplement to diabetic foot surgery due to its regenerative capabilities. With regards to the skin tightening, PRP has been reported to induce rapid skin barrier recovery and reduce erythema after resurfacing laser treatment (Fraxel). Such reports suggest PRP’s potential for enhancing the efficacy and reducing the adverse effects associated with fractional laser treatment (Fraxel).  therapy used for treating acne scar and wrinkle removal and skin tightening.

Unlike other ordinary scar and wrinkle removal and skin tightening created by a wound trying to heal itself and the resulting overproduction of collagen, atrophic acne scar and wrinkle removal and skin tightening are produced by destruction of the dermal matrix, followed by imperfect matrix synthesis or repair. Therefore, most acne scar and wrinkle removal and skin tightening treatments work by inducing regeneration and remodeling of the dermal matrix. Until now, ablative laser treatment (Fraxel).  Resurfacing has been regarded as the gold standard treating atrophic acne scar and wrinkle removal and skin tightening. However, resurfacing provided by conventional ablative laser treatment (Fraxel).  The treatment produces additional cutaneous maladies such as hypertrophic scar and wrinkle removal and skin tightening or permanent hypopigmentation. With the development of technology, fractional laser treatment (Fraxel). Therapy was developed to reduce these adverse effects, even safe for dark skin and within a month after taking isotretinoin. Although the remaining viable epidermis and formation of rapid fibrin plug often accelerate postoperative recovery, such therapeutic effects are often limited. While high-energy laser treatment (Fraxel).  treatment can increase therapeutic efficacy, it can also increase the chance that a patient will experience adverse side effects.

advanced acne scars before and after

 

Discussion

Application of growth factors enhances tissue regenerative properties and increases the speed and success of wound healing. Various growth factors are known to be contained in platelets. Activated PRP contains high concentrations of various growth factors, and is often used in the post-operative care of problematic wounds in diabetic patients. The growth factors in (PLASMA INJECTION, VAMPIRE FACIAL) are assumed to increase the regenerative ability of damaged tissue in acne patients undergoing laser treatment, and thus increase its efficacy.

The superior clinical efficacy of PRP (PLASMA INJECTION, VAMPIRE FACIAL) combination treatment shown in our current study concurred with results reported in a previous study. In the present study, the superior clinical efficacy of combined laser/PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment was confirmed using two different evaluation tools. Additionally, our study showed the superiority of the PRP (PLASMA INJECTION, VAMPIRE FACIAL) combination therapy in treating all types of acne scar and wrinkle removal and skin tightening. Numerous studies have reported improved results when treating acne scar and wrinkle removal and skin tightening with a fractional laser (Fraxel). Our data also indicated that two sessions of fractional laser therapy (Fraxel) produced a significant improvement (∼50%) in scar and wrinkle removal and skin tightening compared with baseline evaluations.

PRP (PLASMA INJECTION, VAMPIRE FACIAL) is known to elevate levels of TGFβ, which is thought to be an important modulator of fibrosis. TGFβ purified from human platelets has been shown to promote collagen formation and increase fibroblast proliferation; however, these effects have not been demonstrated by PDGF or EGF. Especially, fibroblast proliferation positively correlated with TGFβ1 expression during the early stages after fractional laser. The in vivo data from our current study suggest that the effects of PRP (PLASMA INJECTION, VAMPIRE FACIAL) may be mediated by TGFβ.

The clinical photo shows the higher efficacy of combined laser/PRP treatment compared to combined laser/NS treatment. (A and B) Fractional CO2 laser plus PRP treatment (C and D) Fractional CO2 laser plus NS treatment (A and C) without any treatment, (B and D) 4 weeks after two sessions of treatment.

PRP (PLASMA INJECTION, VAMPIRE FACIAL)-treatment induced elevated expressions TGFβ1 and TGFβ3 as determined by both IHC studies, and also led to dense collagen depositions. TGFβ3 has been attempted to decrease the scar and wrinkle removal and skin tightening response. Therefore, an increase of collagen deposition may be induced by the comprehensive effect of changes of TGFβ1 and TGFβ3.

C-myc has been regarded as an important regulator of cellular growth control. The increase of c-myc expression resulted in cell cycle progression. Presumably, c-myc may act as a mediator between signals from growth factors released by PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment and cell proliferation. Cooperation of c-myc and TGFβ may play a positive role in some conditions such as epithelial-mesenchymal transition which is common in wound healing process. In our study, expressions of TGFβ and cmyc were higher on the PRP (PLASMA INJECTION, VAMPIRE FACIAL)-treated side of faces compared to control sides. This result suggests that both TGFβ and cmyc may contribute to increase collagen deposition following PRP (PLASMA INJECTION, VAMPIRE FACIAL) injection.

Clinical efficacy may have an association with total collagen deposition. The increase of TIMP expression by PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment can contribute to increased collagen deposition.

Our in vitro experiments were conducted to clarify the molecular mechanism for the efficacy shown by combined fractional laser/PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment. Laser irradiation induced morphological changes in fibroblast cells, presumably due to heat energy transfer. To exclude the simple effect of serum, the effects of PDP treatment were compared with those of PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment. Although PDP induced a rapid recovery from laser insult, PRP (PLASMA INJECTION, VAMPIRE FACIAL) induced a more rapid recovery, and also the proliferation of fibroblasts. When examined from the standpoint of cellular proliferation, the results of our current study support those reported in earlier studies which suggested the proliferative effect of PRP (PLASMA INJECTION, VAMPIRE FACIAL) on fibroblasts.

The overall expression patterns of TGFβ, collagen, and Akt were similar to their respective protein expressions. Such results suggest that these molecules which were increased by PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment may have a common connection. Akt signaling is known to be involved in cell survival, and a recent study revealed its role in wound healing through matrix regulation.

PRP (PLASMA INJECTION, VAMPIRE FACIAL) has been reported to reduce the incidence of adverse effects produced by fractional laser therapy (fraxel). In the current study, erythema and edema were less severe on the PRP (PLASMA INJECTION, VAMPIRE FACIAL)-treated side of each face compared to the NS-treated side. Reduction of inflammation by PRP (PLASMA INJECTION, VAMPIRE FACIAL) can be suggested as possible mechanisms for reduced erythema and edema. Upregulation of TGFβ and HGF supports the suppressive role of PRP (PLASMA INJECTION, VAMPIRE FACIAL) against laser-induced inflammation With the supplementary data, the anti-inflammatory effect of PRP (PLASMA INJECTION, VAMPIRE FACIAL) may have an association with decreased levels of C-FOS and AP-1 pathway, thus increasing clinical efficacy.

Upregulation of EGFR and downregulation of keratin 16 in keratinocytes suggest a benefit of PRP (PLASMA INJECTION, VAMPIRE FACIAL) in laser-induced wound healing. The increase of EGFR expression implies that PRP (PLASMA INJECTION, VAMPIRE FACIAL) may affect epithelial proliferation and migration in wound healing process. Downregulation of keratin 16 indicates that protective effect of PRP (PLASMA INJECTION, VAMPIRE FACIAL) against laser-induced damage in keratinocyte.

Conclusion

Wound healing is a dynamic process over a long period. It is beneficial to observe the process over a long span of time rather than a short period. PRP (PLASMA INJECTION, VAMPIRE FACIAL) is a complex material containing various growth factors. Thereby, it is ideal to investigate changes in various growth factors contained in PRP (PLASMA INJECTION, VAMPIRE FACIAL). Unlike atrophic scar and wrinkle removal and skin tightening, hypertrophic scar and wrinkle removal and skin tightening have its distinctive characteristics. Clinical effects of laser plus PRP (PLASMA INJECTION, VAMPIRE FACIAL) on the hypertrophic scar and wrinkle removal and skin tightening are difficult to predict. Thus, to specify the mechanism of PRP (PLASMA INJECTION, VAMPIRE FACIAL) action, future study should focus on treating other scar and wrinkle removal and skin tightening types such as hypertrophic scar and wrinkle removal and skin tightening with PRP (PLASMA INJECTION, VAMPIRE FACIAL) and assessment of changes in various growth factors including TGFβ by PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment. In summary, PRP (PLASMA INJECTION, VAMPIRE FACIAL) injections increased the efficacy of l laser treatment (Fraxel) for acne scar and wrinkle removal and skin tightening. Increased levels of TGFβ can be suggested as a mechanism for the clinical improvement shown when using combined fractional laser (Fraxel) /PRP (PLASMA INJECTION, VAMPIRE FACIAL) treatment.

Important note: most of this post is copied or cited from an article published by Hun Suh el al. entitled “Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation” publish in Lasers in surgery and medicine.

Sincerely

Dr. Kamal Alhallak

Ph.D., MSc, CDE, CRE, APA, MBA candidate

 

 

2018-01-12T20:25:31+00:00

About the Author:

Ph.D., MSc, CDE, CRE, APA, MBA candidate, Director of Albany Cosmetic and Laser Centre INC
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