Editorial

Platelet-rich plasma in facial aging

0000-0001-5795-7979Yurisbel Tomás Solenzal Álvarez^{1  *}  , 0000-0002-6693-5840Tatiana Hernández González¹  , 0000-0002-0900-3131Alexis Hernández González¹ 

¹Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus, Cuba.

Platelet-rich plasma is defined as a fraction of plasma obtained from autologous blood, with a platelet concentration higher than that of plasma under baseline conditions; containing not only a high level of platelets, but also of growth factors that are actively secreted by platelets; furthermore, this product is rich in proteins that act at the cell adhesion level (fibrin, fibronectin and vitronectin), thus providing the necessary structural support for cell migration and for the proliferation and three-dimensional growth of the tissues on which it acts; it has effects not only directly on the target cells for growth factors, but also as an extracellular matrix for the stimulation of tissue repair and/or regeneration in a global way. ^1,2,3) The most important of these effects is biostimulation; ^4,5,6 process in which these elements act in a combining, synergistic and multidirectional way instead of in a unidirectional way.

Related to the subject, several in vitro and in vivo studies and clinical trials have confirmed that these autologous blood-derived products (growth factors) that are present in fibrin matrices and their biomolecules exert influence on the mechanisms that govern repair tissue, with multiple biological effects: angiogenic, antiapoptotic, chondrogenic, chemotactic, biosynthetic, myogenic, neurogenic, immunomodulatory and anti-inflammatory, antifibrotic, and analgesic. These matrices enhance the endogenous repair process in multiple types of lesions in both non-sterile and sterile inflammatory defects, examples of which: osteoarthritis, tendinopathies, cartilage lesions, peripheral neuropathies, burns, skin ulcers, corneal ulcers, syndrome of dry eye and aging process. ⁷

Clinical studies carried out to treat diseases such as androgenetic alopecia show that autologous growth factors, which significantly reduce hair loss, are an excellent alternative to increase capillary thickness and density; ⁸ which confirms once more that trichology is another area of Dermatology that has also benefited from the regenerative potential of plasma rich in growth factors.

The aging of the skin is produced by the degradation of cells, diminished vascularization, fat atrophy and the sustained process of relaxation-contraction of the muscles. The most common visible signs are wrinkles and dyschromy, some others are less evident such as: loss of texture, tone, color and shine, the orbital partition is weakened which allows the fatty compartments of the upper and lower eyelids to protrude It is a multifactorial phenomenon that affects all levels of the body and not always coincide with age due to the influence of intrinsic and extrinsic factors that accelerate it. ⁹

Anti-aging medicine has had a boom due to the preventive and therapeutic benefits associated with it; its procedures are aimed at improving the quality of life during the normal aging process through the introduction of technological advances; for this reason, it is necessary the searching of alternative treatment that can reduce the signs of aging, as well as to find a source of curative material, which constitutes a challenge for science, especially pharmacology, cosmetology and cosmetic surgery. The restorative treatments used in plastic surgery are a novel alternative, especially cutaneous biostimulation with platelet-rich plasma. ¹⁰

Growth factors and signaling molecules are key elements that direct in a coordinated manner some of the main events of the skin regeneration and restoration phase; in this sense, platelet-rich plasma therapy is postulated as a regenerative therapy that requires a process of scientific and medical systematization to demonstrate its efficacy and safety in a multitude of conditions based on scientific evidence. ¹¹ These therapies are based on obtaining an autologous platelet concentrate from the patient's own blood, which reduces the risk of adverse reactions. The versatility of this drug allows the development of different therapeutic formulations such as: a semisolid clot, an injectable liquid, a fibrin membrane, a three-dimensional gel, a supernatant and a topical serum; these pharmaceutical variants have been used to treat chronological skin aging and to counteract the effects of overexposure to the sun. Different clinical studies indicate that this technology reduces transepidermal water loss, which improves surface hydration in addition to reducing mild and moderate expression wrinkles through the induction of the activity of dermal fibroblasts and a greater deposition of collagen and elastin in connective tissue. ⁷

This therapy is one of the most innovative medical tools in regenerative medicine, its beneficial effects on skin rejuvenation are evident, although the mechanism of action of growth factors is a field in which much remains to be investigated. In the field of cosmetic and aesthetic medicine there are several ways to use the effects of plasma rich in growth factors topically for its stimulating effects on the dermal fibroblast, within this in the form of a clot as a mask, after peels chemical or physical, after laser resurfacing, as a biostimulator of skin regeneration; it can also be used in the form of a clot to fill scars, wrinkles or grooves such as the orbital socket. ¹²

Studies have been carried out where the results are evaluated through a patient satisfaction scale, an objective scale using photographs before and after treatment, biophysical studies of the skin (hydration, roughness and elasticity) and a morphological analysis in skin biopsy, demonstrating a significant increase in the scale of patient satisfaction, skin elasticity and collagen density. ¹² Also with the aim of performing cutaneous biostimulation, platelet-rich plasma can be used intradermally as mesotherapy for the treatment of wrinkles, elastosis or dyschromy; in this way, the production of type I collagen by the fibroblast cell is stimulated and produces notable clinical changes on aging skin, restores skin vitality, increases skin thickness, recovers elastic consistency, smoothes fine lines of expression. , decreases the size of pores, improves vascular flow, stimulates secretions and improves the smoothness, color and appearance of the skin. Growth factors regulate the remodeling of the epidermis and dermis and have a great influence on the appearance and texture of the skin. ^13,14

The “lipofiling” technique or fat infiltration, ¹³ is used for facial remodeling as a single treatment or associated with surgery; ^15,16 adding platelet growth factors to these fat grafts to obtain a more permanent result without reabsorption. ¹⁶

Platelet growth factors act as cellular signals that bind to membrane receptors to activate cellular functions, they are biological mediators that regulate essential functions in tissue regeneration and repair, chemotaxis, mitosis, angiogenesis, proliferation, differentiation and cellular modulation; which induces the production of extracellular matrix, therefore when using them it helps to stabilize and favor the integration of the fat micrografts in the remodeled area, they are used in Plastic Surgery to enrich the fat that infiltrates at the facial level in malar areas, chin, nasolabial folds, lips, etc. Also as facial mesotherapy and as clot-shaped filler in areas such as the orbital basin grooves (“Tear Through”), among others. The objective of the described technique is to achieve facial rejuvenation and the replacement of facial volumes. ¹⁷

In the provincial doctor´s consultation of Plastic Surgery at Camilo Cienfuegos General Provincial Hospital of Sancti Spíritus, a high incidence of patients with signs of facial aging requesting regenerative treatment has been evidenced through the charge sheets. Surgical treatments are invasive, expensive and many times do not resolve minor defects, cosmetic therapy and its wide diversity are not available to the Cuban health system in addition to the countless complications that can accompany it, so it is necessary to carry out treatment studies with platelet-rich plasma to evaluate its effectiveness and safety.

REFERENCIAS BIBLIOGRÁFICAS

1.  Mehta S, Watson JT. Platelet rich concentrate: basic science and current clinical applications. J Orthop Trauma [Internet]. 2008 [cited 2020 Jul 29];22(6):432-8. Available from: Available from: https://journals.lww.com/jorthotrauma/fulltext/2008/07000/platelet_rich_concentrate__basic_science_and.12.aspx 1.

2.  Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg [Internet]. 2004 [cited 2020 Jul 29];62(4):489-96. Available from: Available from: http://www.drkoprp.com/pdfs/prp/PRPbyDr.Marx.pdf 2.

3.  Rodríguez Flores J, Palomar Gallego MA, Torres García-Denche J. Plasma rico en plaquetas: fundamentos biológicos y aplicaciones en cirugía maxilofacial y estética facial. Rev Esp Cirug Oral y Maxilofac[Internet]. 2012 [citado 29 Jul 2020];34(1):8-17. Disponible en: Disponible en: http://scielo.isciii.es/pdf/maxi/v34n1/original2.pdf 3.

4.  Knezevic NN, Candido KD, Desai R, Kaye AD. Is Platelet-Rich Plasma a Future Therapy in Pain Management? Med Clin North Am [Internet]. 2016 [cited 2020 Jul 21];100(1):199-217. Available from: Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0025712515001522.pdf?locale=es_ES&searchIndex 4.  =

5.  Le Adrian DK, Enweze L, DeBaun MR, Dragoo JL. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med [Internet]. 2018 [cited 2020 Jul 21];11(4):624-634. Available from: Available from: https://barkerstreetspecialists.com.au/wp-content/uploads/2019/03/Current-Clinical-Recommendations-for-Use-of-Platelet-Rich-Plasma-.pdf 5.

6.  Castro-Piedra SE, Arias-Varel KA. Actualización en plasma rico en plaqueta. Acta méd costarric [Internet]. 2019 [citado 22 Jul 2020];61(4):142-51. Disponible en: Disponible en: https://www.scielo.sa.cr/pdf/amc/v61n4/0001-6002-amc-61-04-142.pdf 6.

7.  Anitua E, Prado R, Pino A, Muruzabal F, Padilla S. Plasma rico en factores de crecimiento (PRGF): los fundamentos moleculares para sus aplicaciones terapéuticas en diferentes tejidos y patologías. Rev Odontología Molecular SEBBM [Internet]. 2019 [citado 20 Jul 2020];202:18-23. Disponible en: Disponible en: https://fundacioneduardoanitua.org/wp-content/uploads/2020/01/Art%C3%ADculo-3-plasma-rico-en-factores-de-crecimiento-prgf-los-fundamentos-moleculares-para-sus-aplicaciones-terapeuticas-en-diferentes-tejidos-y-patologias.pdf 7.

8.  Sánchez Linares V, Nieda Rosales L. Plasma rico en plaquetas contra la alopecia androgénica. Gac Méd Espirit [Internet]. 2019 [citado 21 Jul 2020];21(2):1-7. Disponible en: Disponible en: http://scielo.sld.cu/pdf/gme/v21n2/1608-8921-gme-20-02-1.pdf 8.

9.  Escobar HM. Terapia de bioestimulación con plasma rico en plaquetas para el envejecimiento cutáneo. Rev Argent Dermatol [Internet]. 2012 [citado 20 Jul 2020];93(1). Disponible en: Disponible en: http://rad-online.org.ar/2012/04/01/terapia-de-bioestimulacion-con-plasma-rico-en-plaquetas-para-el-envejecimiento-cutaneo/ 9.

10.  Planas Pavón M, González Piedra M, Zamora Santiesteban Y, Fuentes Céspedes O. Aplicación del plasma rico en plaquetas en la especialidad de cirugía plástica y caumatología. Invest Medicoquir [Internet]. 2019 [citado 20 Jul 2020];11(Supl.1). Disponible en: Disponible en: https://www.medigraphic.com/pdfs/invmed/cmq-2019/cmqs191zc.pdf 10.

11.  Alcaraz-Rubio J, Oliver-Iguacel A, Sánchez-López JM. Platelet-rich plasma in growth factors. A new door to regenerative medicine. Rev Hematol Mex [Internet]. 2015 [cited 2020 Jul 21];16(2):128-42. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/hematologia/re-2015/re152e.pdf 11.

12.  Badran K, Sand J. Platelet-Rich Plasma for Hair Loss Review of Methods and Results. Facial Plast Surg Clin North Am [Internet]. 2018 [cited 2020 Jul 21];26:469-485. Available from: Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S1064740618300324.pdf?locale=es_ES&searchIndex 12.  =

13.  Rodríguez-Segura A, Montoya-García C, Pacheco-López RC. Rejuvenecimiento facial: cambios clínicos e histológicos con la aplicación de plasma rico en plaquetas. Cir Plast [Internet]. 2016 [citado 2020 Jul 21];26(3):132-139. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/cplast/cp-2016/cp163e.pdf 13.

14.  Díaz Y. Plasma Gelificado: Técnica de Obtención. (Plasma Gel). Dermatol Venez [Internet]. 2017 [citado 22 Jul 2020];55(2). Disponible en: Disponible en: http://revista.svderma.org/index.php/ojs/article/view/1401/1383 14.

15.  Koethe JR, Lagathu C, Lake JE, Domingo P, Calmy A, Falutz J, et al. HIV and antiretroviral therapy-related fat alterations. Nat Rev Dis Primers [Internet]. 2020 [cited 2020 Jul 21];48(6). Available from: Available from: https://www.nature.com/articles/s41572-020-0181-1 15.

16.  Serra Renom JM, Muñoz del Olmo JL, Gonzalo Caballero C. Uso de factores de crecimiento plaquetar unidos a injertos de grasa para lipofiling facial en ritidectomía. Cir Plas Iberolatinoam [Internet]. 2006 [citado 21 Jul 2020];32(3):191-198. Disponible en: Disponible en: http://scielo.isciii.es/pdf/cpil/v32n3/original6.pdf 16.

17.  Tenjo Aguirre EM, Silva Briones GA. Efectividad de la aplicación de Células Madre y Factor de Crecimiento Plaquetario en el tratamiento de mujeres de 40 a 60 años que presentan Involución Cutánea facial, atendidas en la unidad de medicina y cirugía estética Renove de la ciudad de Guayaquil 2016-2017. [Tesis titulación previo a la obtención del título de Licenciadas en Nutrición Dietética y Estética Internet]. Ecuador: Universidad Católica de Santiago de Guayaquiles; 2017. [citado 21 Jul 2020]. Disponible en: Disponible en: http://repositorio.ucsg.edu.ec/bitstream/3317/7560/1/T-UCSG-PRE-MED-NUTRI-222.pdf 17.

Received: August 27, 2020; Accepted: September 28, 2020

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran no tener conflicto de interés en esta investigación.