Combination therapies with platelet-powered plasma in cosmetic dermatology

Platelet-rich plasma (PRP) therapy is a plasma component that has a higher platelet concentration after centrifugation of autologous blood placed in a citrated blood tube, which has become increasingly popular and widely used in recent years. The purpose of the use of PRP is to accelerate tissue repair, directly and indirectly, by increasing the release of growth factor at supraphysiological concentrations by decreasing the erythrocyte count and increasing the platelet count. For the clinical effect of PRP, its regenerative effect on the wound is mentioned when it is at least 4 times the basal value (150 000-400 000/μl), that is, over 1 000 000/μl.1-4 Cell regulation, differentiation of growth factors in the wound healing process, Having valuable roles in proliferation, chemotaxis, angiogenesis, and matrix synthesis processes proves that PRP, which is rich in growth factors, can be used in this process.5-8 PRP’s fibroblast proliferation, which is necessary in the wound beautification process, Matrix metalloproteinase (MMP) ) 1-3, and an increase in type 1 collagen has been proven to increase the synthesis of the extracellular matrix (ECM). -13 If the timing of the PRP is expensive; The bioactivity of the concentrated platelets in PRP continues for 6 hours and PRP needs to be injected within 3 hours. In CaCl2-activated PRP, on the other hand, 70% of the stored GFs are released within 10 minutes after activation, and nearly 100% within the first hour. Therefore, it is recommended to be applied as soon as possible after activation. It is worth paying attention to this timing, especially in terms of methods that can be used with PRP.10,14 Uses of PRP in dermatology; In addition to chronic wounds, ulcers and burns, it has been successfully used in the field of cosmetic dermatology based on the principle of wound smoothing.15-18 In addition to being used alone, PRP can be used after invasive/non-invasive cosmetic procedures (eg, chemical peeling, roller, laser, RF, etc.) can also be used in combination with these systems to increase and accelerate wound healing.12,19 Although there are not many combinatorial studies in the field of cosmetic dermatology, it has been inaccurately proportional to the increasing popularity of PRP recently. The number of studies conducted in this form is gradually increasing. For the treatment of melasma and postinflammatory hyperpigmentation (PIH), PRP application can be combined with other treatment options. TGF-b1 has melanogenesis inhibitory properties.20 Therefore, PRP highly rich in TGF-b1 can be used alone or in combination with laser, chemical peeling, mesotherapy and rollers in melasma or PIH. It is inevitable that topical application after processes such as laser, chemical peeling, and roller for the treatment of melasma will create a synergistic effect. In addition, it has been proven that erythema, edema, pain and sensitivity that may occur as a result of these processes decrease with the application of PRP and increase patient satisfaction.9,12,19,21,22 PRP application can also be added after hair transplantation. The rationale for adding PRP treatment; It is in the form of obtaining stronger and fuller hair growth with angiogenesis facilitating growth factors such as VEGF8 and PDGF4 in its content and minimizing the 15-30% hair loss lost by elimination and absorption after the process. The combination of 4-6 sessions of PRP application after hair transplantation has started to be applied as a standard.23-27 Laser treatments and PRP application can be used in combination. After the fractional CO2 laser, the topical application of PRP to the laser applied areas reduces the risk of acute side effects such as erythema, tenderness, edema, acne, milia and scar formation, permanent erythema and post-inflammatory hyper-hypopigmentation, accelerates the beautification, and It has been shown that the results obtained as a result of its combination with PRP are smoother.9,21,28 In a study conducted for acne scars, unilateral PRP application in the form of mesotherapy was applied to 14 patients after the ablative CO2 laser peeling process. Erythema, edema, and tenderness were found less in the area where the procedure was performed. In addition, the level of smoothing of acne scars in the control examination 4 months later was found to be higher on the PRP applied side. It has been found that combined PRP applications are much better in terms of reduction of erythema and edema, and show more improvement than saline in terms of total improvement. The results of topical PRP application were found to be close to each other compared to intradermal application, and it was emphasized that topical PRP application should be preferred because the pain scoring is very different. It has been proven in event studies that it gives more adequate results in terms of both results and faster recovery compared to the previous studies.9,21,28,31 In the study conducted for posttraumatic scars; Fractional ErYAG was applied to one side of the scars and topical PRP was applied to the other side after fractional ErYAG laser application. It was found that the side combined with PRP became more beautiful compared to the scar severity scale.32 In another study conducted for the treatment of traumatic scars, after the application of fat graft mixed with PRP to a group of patients and the application of a 1540 nm non-ablative Er-Glass laser combination application, these procedures were only Better results were obtained after application with combinations than when applied alone.33 In a study of 22 patients for acne scars, topical PRP treatment was given to each patient after 3 fractional ErYAG applications, erythema lasted less than 3 days, and acne inflammation was not observed. The improvement in acne scars was reported to be in the middle of 50-90%.34 PRP can also be combined with RF treatments. In a study conducted on 19 Asian female patients in which the combination of PRP with Bipolar RF was evaluated for the treatment of striae; 3 sessions of bipolar RF were applied intradermally to the striae areas at 4-week intervals, and then PRP was re-administered to the striae areas. In the evaluation, it was concluded that the combination therapy improved the striae statistically significantly.35 In another study conducted on 18 patients for the treatment of striae, a method in which unipolar RF combined with ultrasound waves was applied to the striae areas, and then an ultrasound head was used. PRP was applied to striae areas; Statistically satisfactory results were obtained as a result of applying this combination every 2 weeks for a total of 4 sessions. 36 Although there are no evidence-based examples in the literature yet, the combination of PRP with chemical peeling and microneedling (roller) application would be appropriate. ; In addition, it can be said that 2-4 sessions of PRP application would be appropriate to increase the rejuvenation and revitalization effect on the skin before BoNTA and filler applications. As a result; Combining applications made in the field of cosmetic dermatology with PRP has recently become popular and is becoming increasingly common. Since it is an autologous product, it does not pose an allergic reaction risk, faster recovery of acute side effects (erythema, edema, etc.) caused by the processes performed and permanent side effects (PIH, It is obvious that the combination of PRP with cosmetic applications will increase day by day.

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