58 FORUM I body language
fuged at a specific, low speed for eight minutes, we have a separation of the plasma and the red cells. By pressing on the plunger, the red cells are pushed down and we have our plasma—20cc in one manipulation. After that, we use a two-way connector to extract into a 1ml syringe if it’s easier to use or to mix it with hyaluronic acid. We get the plasma without any chemical separation and no need for human or bovine thrombin. I want the PRP to be totally autologous unless I want to mix it with hyaluronic acid. Angel Lift System Dr Kambiz Golchin: Rather than dealing with tubes, I like to use a fully-closed, automated system that does the job very simply. With the Angel system, we extract around 52ml of blood and push the plunger in, which then and it’s going to goes into a reservoir bag. The system then makes the PRP automatically, depending on the settings that we give it. We can choose the amount of red or white blood cells, and adjust the volume so we can generate less or more, depending on need. The 2012 Cochrane Review stated that there is no clear evidence that PRP works. So why are we using it? Contrary to the Review, we know that there is evidence that it works. A systematic review in the Journal of Plastic & Aesthetic Surgery shows clearly that PRP works in fat grafts. There is some evidence in wound care for diabetic foot ulcers. However, these are different indications and they need different formulas. So we can’t use the same PRP for all treatments and get great results; it just won’t work. PRP is not a filler, so we’re not going to get a filling effect from it. As there are different indications, we have to be specific with formulations. Aesthetic indications require different settings, for example white cells do something different, as do platelets. Selphyl Dr Hema Sundaram: The Selphyl system produces Platelet Rich Fibrin Matrix (PRFM), a unique
type of PRP that has a fibrin scaffold from which there is gradual, controlled release of growth factors and cytokines. One of the important features is that the PRP is free of red blood cells—it’s pure yellow. If you’re looking at bringing PRP into your practice, look at two or three different systems and figure out what’s going to work for you and your patients. I just published a new peer-reviewed scientific paper. The Potential of Topical and Injectable Growth Factors and Cytokines for Skin Rejuvenation in the special issue of the journal, Facial Plastic Surgery that is in conjunction with the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) International Symposium. It provides an evidence-based update on PRP, with a comprehensive review of the available data and explanation of the different formulations. With the Selphyl system, I’ve developed a two-layer technique to optimize results and minimize recovery time. I use a 27 gauge blunt cannula to inject PRFM into the superficial subdermal plane, for a nice, even distribution. This is non-traumatic to the skin. Patients who have a tendency to get swelling after HA filler injections often ask for PRFM. By making the procedure as non-traumatic as possible, as a general rule, my patients can walk out of my clinic with no bruises at all. I then use a sharp 30 or 32 gauge needle for precise intradermal injection of PRFM. This dual plane injection technique achieves superficial volumising, with a subsequent skin boosting effect. It’s notable that the Selphyl system allows a full 10-minute window period between the formation of the PRFM and time of injection. Injection of PRFM into the dermis can dramatically improve light reflectance of the skin, which is very helpful for dark circles under the eyes and to restore skin radiance. It isn’t just about volumising and generating collagen; to alter skin reflectance is a significant benefit. Does PRP work? Dr Fraser Duncan: PRP is not one
single substance and the clinical evidence for its use is controversial. There are four main questions for anyone considering using PRP. The first is how pure is it and is it sterile? How much does it cost to set up and use? How easy is it to use? And does it work? Dr Daniel Sister: In 1950, two doctors were awarded the Nobel Prize when they discovered a growth factor in plasma. In 1970, Marx proved that he helped to treat receding gums and peripheral bone structure and since then, more than 6,000 studies have been published. So there is hard evidence that PRP works. From my own experience, we are currently reviewing over 700 treatments I’ve performed and we have over 70% satisfaction rates. When people say PRP is not a filler, I agree. It’s not a filler but because it helps to generate type 1 collagen, regenerate more vascularisation and helps all the cells to function, there is a filling effect—not as much as if you were to use a filler, but there is a filling effect. PRP is totally natural and autologous, so you can mix it with any other treatment. You can mix it with fractional laser, hyaluronic acid or with any other treatment to have a stronger or longer-lasting filling effect with fewer side-effects. It is definitely the most versatile and efficient treatment. Dr Kambiz Golchin: I truly believe in PRP—I quoted the Cochrane Collaboration which looks at all the evidence that has been published. The National Institute for Health and Care Excellence have a report on the subject as well. The reason for all the confusion is because of the differences in PRPs. What is the definition of PRP? There are differences in the definition—is it just superphysiological or does it have to be at least two-fold? There is no consensus on what the correct definition is. I agree that growth factors are key to the effect of PRP but growth factors are not directly related to platelet count. Dr Alain Gondinet: We need to go back to the basics and to FDA approval. According to the FDA’s definition, when we use a medical device kit, we need to have a
PRP is natural and autologous, and can be combined with other treatments for longerlasting effects