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Archive for the ‘platelet-rich plasma’ Category

Platelet-Rich Plasma (PRP) in Fat Grafting

Saturday, July 18th, 2015

 

Fat Injection Indianapolis Dr Barry EppleyFat grafting is one of the great innovations in plastic surgery of the past decade as a stand alone procedure or as a complement to many other plastic surgery procedures. As a natural graft material with usually good availability, it is an unrivaled aesthetic and reconstructive soft tissue reconstruction method. But despite its many attributes, fat grafting is not a completely reliable soft tissue creation method. Much investigation and study has gone into fat harvest and graft preparation and injection, but no universal method has been discovered that can consistently produce a consistently reliable graft take.

One fat graft preparation method that has been looked at over the years is the addition of a ‘priming’ or stimulating agent. The objective is to either improve how many of the intact transplanted fat cells will survive or increase conversion of the coincidental stem cells that are known to exist in fat to become new lipid-laden fat cells. Done years ago by mixing in insulin, today’s potential fat graft stimulator is platelet-rich plasma. (PRP) High concentrations of platelets would theoretically have a favorable effect on both adipocytes and stem cells.

Platelet Rich Plasma Injections Indianapolis Dr Barry EppleyPRP is a natural blood extract product that is rich in growth factors that have well documented effectiveness in wound healing. Through such growth factors as PDGF, TGF beta and VEGF, improved blood vessel ingrowth and deposition of extracellular matrix has been shown in many animal studies. Animal studies have also shown that PRP can improve fat graft take and reduce the formation of oil cysts most likely due to its revascularization effects. But despite the theory and animal research the use of PRP in fat grafting remains speculative with few clinical studies that have even investigated its potential effects.

Like any drug, the effects of PRP on fat would be expected to be dose dependent. Given that the average PRP volume extracted from a 20 to 60cc blood draw would be just a few ccs, its addition for example to a BBL (Brazilian Butt Lift) would be expected to have no effect on fat graft survival. In facial fat grafting, however, where graft volumes could be expected  to be between one and 50ccs, a few ccs of PRP would be more likely to be effective. Thus it likely all comes down to an expected concentration effect.

No one yet knows what the ratio of PRP to fat graft volume should be or would be expected to work. I currently operate on the theory that PRP should be used when the fat graft to PRP ratio is at least 10:1 or a 10% PRP composition volumetric ratio. Studies have shown that PRP may have its strongest effect on the differentiation of adipocyte-derived stem cells into fat cells. This may make the greatest contribution to final graft volume persistence. While vascular budding or endothelial sprouting may have a more minor effect.

The use of PRP in fat grafting (lipofilling) remains more theoretical than proven science. But the lack of any side effects with PRP allows for the its liberal clinical use and investigation.

Dr. Barry Eppley

Indianapolis, Indiana

PRP (Platelet Rich Plasma) Therapy for Hair Regeneration

Thursday, January 8th, 2015

 

Hair loss is incredibly common for both men and women. The use of non-surgical topical Minoxidil and oral Propecia as well as surgical hair tranplantation are well known and offer hair maintenance and hair restoration benefits to many. But between these two type of treatmets lies an intermediate hair therapy that has been historically lacking…a form of injectable therapy. That role is now beginnning to be filled with PRP therapy. PRP injections are a non-surgical method of hair stimulation that can be used for both men and women.

Platelet Rich Plasma Injections Indianapolis Dr Barry EppleyWhat is PRP? PRP (platelet rich plasma) is an extract of human blood that is an isolated concentration of platelets which contain high levels of specific growth factors that are well known to induce tissue regeneration and healing. When injected into the scalp, a growing body of medical evidence indicates that it is promising treatment option to promote hair growth. It is important to understand that PRP is derived directly from the patient so it is a completely natural blood product. While PRP has been around for years it has largely been a technology relegated to the hospital and use in major surgery. With today’s technologic advancements, PRP is now available to be used in an office setting for numerous aesthetic treatments such as hair regeneration.

How does PRP for hair growth work? It is postulated that PRP can cause the growth of hair through stimulation of the stem cells located in the dermal papilla of the hair follicle.(bulb) It is very likely that it may stimulate other structures in the hair follicle as well. PRP may induce a hair follicle to change from the resting staten (telogen) to the growth phase.(anagen) This may ‘wake up’ dormant hair follicle and/or may cause active ones to grow faster or develop slightly thicker hair shafts.

How is PRP done? A small amount of blood is drawn in the office, mixed with an antocoagulant and spun in a centrifuge for around 10 minutes. This process separates the blood into various fractions, one of which is the platelet layer or platelet rich plasma fraction. The pure PRP can then be injected into the scalp using small needles directly below the skin (hair follicles are below the skin not in it) or the microneedling can be done onto which it is applied topically. Treatments can be repeated every four months if needed to see optimal results. (hair follicle take months to grow out and see a visible shaft)

PRP Hair Regeneration Men Dr Barry Eppley IndianapolisPRP Hair Regeneration for Women Dr Barry Eppley IndianapolisWho is a good candidate for PRP hair regeneration? While individual results vary and no guarantee can be given that hair will grow, PRP works best in thinning hair. It will not take a ‘desert’ and turn it into a lush garden. It is not a magic potion that can make hair appear that has been completely absent for decades. Rather it requires some follicles to be present for its stimulatory effects to be seen. This is why it works just as well for women (maybe even better than men) because they may have more active follicles initially anyway. PRP is a good adjunctive therapy to be used both before and after hair transplantation. It is also an excellent treatment for those patients who have lost their hair from chemotherapy. (follicles induced into telogen by chemical poisons)

PRP is an emerging non surgical based therapy for natural stimulation for thinning hair. PRP is completely safe and natural because it contains the patient’s own blood product. The scientific evaluation of the effectiveness of PRP therapy for hair regeneration is currently under clinical trial investigation and its efficacy is currently based on anectodal and case report evidence only. Thus it should not be considered FDA approved or view as a ‘baldness cure’.

PRP therapy is a natural alternative for improving hair growth for those patients who do not want surgical hair transplantation. Conversely it is also an adjunctive therapy for those that have already undergone hair transplants. Although results will vary from patient to patient, PRP injections offer improvement in hair caliber and thickness for natural thinning and miniaturization or as a stimulus for newly implanted follicles.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma (PRP) Use In Facial Laser Resurfacing

Sunday, January 4th, 2015

 

Fractional Laser Resurfacing Face Dr Barry Eppley IndianapolisLaser resurfacing is a long-standing treatment that can have a profound rejuvenative effect on wrinkled and sun damaged facial skin. By burning off the top layer of skin and allowing it heal, a fresh skin surface is created with fewer surface imperfections.While effective, it is associated with a significant healing time, discomfort and  temporary facial redness. This has been improved by changing from a fully ablative laser treatment, which treats the entire skin surface, to a fractional approach.

Fractional laser resurfacing treats a portion or fraction of the skin surface’s  (usually 5% to 22%) but with deeper channels cut down into the thickness of the skin. This has the dual effect of shortening healing time due to less injured skin surface and causing greater collagen regeneration and tightening. But despite the advantages and reduced recovery time of the fractional laser, adjuvant treatments are still sought to reduce healing time and facilitate a faster recovery. One such treatment is that of platelet-rich plasma. (PRP)

Platelet Rich Plasma PRP Therapy Dr Barry Eppley IndianapolisPlatelet-rich plasma (PRP) has been used for many applications in various surgical fields for its ability to improve wound healing, hemostasis, and graft survival. It is a blood concentrate that is full of platelets. Platelets contain many different growth factors and cytokines in high concentrations which serve as the theoretical basis for the use of PRP in tissue repair. Studies are mixed as to its true effectiveness across a broad spectrum of applications. But the superficial nature of laser resurfaced skin seems like a good application for it.

In the Online First edition of the November/December 2014 issue of JAMA Facial Plastic Surgery, a study was pubished entitled ‘Evaluation of the Effect of Platelet-Rich Plasma on Recovery After Ablative Fractional Photothermolysis’. This was a blinded study using small human forearm test sites that were treated with fractional laser treatments at consistent depths in both arms. The treated sites were immediately treated with either topical PRP or saline. (control) Significant improvement was seen in PRP-treated arms compared to controls in all 15 treated patients. Improvement was defined as the erythema rating of the untreated arm minus the erythema rating of the PRP-treated arm. Patients noticed a reduction in the amount of redness, swelling, itching and pain in the PRP-treated sites.

These study results suggest that PRP can improve the healing rate of facial laser resurfacing sites. It presumably does so by creating a faster rate of skin cells growing across the injured skin surface through earlier induction of cell turnover. It is interesting that such positive results were seen with just one application immediately after the laser resurfacing. Given the reduced cost to acquire a single concentrate of PRP today, it should enjoy broader useage.

Dr. Barry Eppley

Indianapolis, Indiana

PRP-Enriched Fat Injection Buttock Augmentation

Thursday, October 3rd, 2013

 

The most popular method of buttock augmentation is by fat injections. Known as the Brazilian Butt Lift (BBL), it is singularly responsible for the dramatic rise in the number of buttock augmentation procedures performed. While fat is not the most reliable method of adding buttock volume, an implant is, it offers a natural material that has an assured positive body contouring effect.

To improve the reliability of injected fat survival, numerous methods of graft harvest, concentration and injection have been proposed and tried. At this point, the differences in these three basic graft procedures is not really that different amongst experienced physicians performing buttock augmentation. Adding pharmacologic agents to the fat has not been well explored up to the present due to the lack of knowing what may be successful.

The most logical additive to fat is PRP, platelet-rich plasma. It is a natural concentrate from the patient’s own blood and has an established history of aiding wound healing and generating angiogenesis through its growth factor and cytokine content. It can be easily added to fat grafts and has been done anecdotally for all kinds of fat grafting with variably reported results.

In the September 2013 issue of the European Journal of Cosmetic Surgery, an article appeared entitled ‘Results and Long-Term Patient Satisfaction After Gluteal Augmentation With Platelet-Rich Plasma-Enriched Autologous Fat’. In this paper, a study was done to investigate the long-term results and patient satisfaction after PRP-enriched lipofilling of the buttocks for aesthetic augmentation. In twenty-four (24) patients, both buttocks were injected with PRP-enriched fat and liposuction done on surrounding contour zones. The mean fat injected was just over 475cc for both sides. No infections, hematoma, seromas or liponecrosis (oil cysts) occurred. Patients were followed out to nearly four years with high patient satisfaction at 3 months after surgery with a slight decline over the remaining study period.

This small study concludes that PRP-enhanced lipofilling is safe with a low complication rate. This would be expected. The real question is does it improve fat injected buttock augmentation results? Unfortunately this study, regardless of the number of patients treated, can not really answer this question. Unless each patient served as their own control (one buttock got regular fat and the other PRP-enriched fat), the results can not be  directly compared.

The other problem with adding PRP to large volumes of fat is the ‘dosing’. Usually only about 6ccs of PRP can be obtained from a 60cc blood draw. When mixed in with hundreds of ccs of fat (in this study 475cc to be exact), it only adds <1% to the total fat injectate. Whether such a small ‘dose’ of PRP is enough to make a difference is unknown but suspect. In smaller volume fat injections like in the face where 5 to 30ccs are more typically injected, this amount of PRP is more likely to have a stimulating graft benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma (PRP) Injections as a Hair Loss Treatment

Wednesday, September 4th, 2013

 

The use of platelet-rich plasma (PRP) injections epitomizes the statement ‘heal thine own self’. Using a patient’s blood, a platelet extract is obtained by centrifugation that can be spot injected to an area of need. Since platelets are well known to be storehouses of growth factors and cytokines, their administration into a variety of wound problems has been shown to expedite healing. Conversely, their application to many cosmetic conerns, such as aging and wrinkles, has shown inconsistent results.

Scalp hair loss or alopecia is a multifactorial issue of which genetics have been shown to be as much a factor as any other identifiable factors. There are a wide variety of hair loss treatments from topical and oral medications to light therapies to hair transplantation surgery. The void between these treatment options is an injectable approach. The concept of adding stimulatory agents to the scalp by direct injection is certainly possible but the question would be what should the injected agent be. That answer is unknown but PRP would be a logical candidate, offering complete safety with potential effectiveness due to its growth factor content.

In the July 2013 issue of the European Journal of Plastic Surgery, an article was published entitled ‘Platelet-Rich Plasma Injection is Effective and Safe for the Treatment of Alopecia’. Over a one year period, 42 patients (mainly men) with androgenic alopecia had their balding scalps injected with 8 to 12 ccs of PRP. Prior to injection a hair pull test was performed. The injections were repeated five times over 2 months or every 10 days. Three months after the last injections, the results were assessed by photographs, hair pull tests and the patient’s satisfaction.

Before the injections, 90% of the patients had a hair pull test which averaged 8 hairs. After the third injection sessions, the hair pull test had decreased to an average of 3 hairs. Photographs showed a significant improvement in hair density and a high resultant high patient satisfaction. Better results were seen in patients who had noticeable hair loss that was less than two years old. Mediocre results were seen in patients with advanced hair loss and marked hair loss patterns.

This study shows that PRP injections into the scalp are ‘simple’, have no real risk and have some demonstrable effectiveness for slowing hair loss and inducing some hair regrowth. Why they may work is speculative. Numerous theories abound such as direct stimulation of the hair follicles by improved vascularity to activation of adult stem cells. The reality is no one knows for sure.

It is no surprise that PRP would have some regenerative effect on hair growth. But how practical is it? It requires repeated injections and I don’t think most patients would call putting 30 or 40 needle sticks into the scalp as ‘simple’, even though technically it is. How often and for how long must the injections be done? Although not stated, just like topical Rogaine or oral Propecia, I suspect treatments must be continued to have a maintained effect. It is not just as simple as that the injections ‘turn back on’ permanently the hair follicles ability for renewed regrowth. (that would require a genetic transformation)

PRP may have a role to play in hair loss treatments but papers such as this one are promising but not yet definitive on its benefits.

Dr. Barry Eppley

Indianapolis, Indiana

Stem Cells and PRP in Plastic Surgery – Anti-Aging Hope or Hype?

Sunday, July 14th, 2013

 

Some have said that the power to slow down aging or to ‘heal thineself’ does not come from some external source such as potion or pills but from within. This has led to the popularity of two natural materials derived from blood and fat. Stem cells (in fat) and platelets are located throughout the body and can be relatively easily harvested and prepared into an injectable form. This permits them to delivered into almost any body site to create either improved healing or a tissue enhancement effect. This has enabled such autologous injections to be used for a wide variety of medical applications including aesthetic and anti-aging applications.

The use of embryonic stem cells in numerous medical diseases is controversial. But the use of adult stem cells for their potential cosmetic and anti-aging effects is not open to as much criticism as there does not seem currently to be much downside. The debate with their use is whether they can live up to the hype. Numerous anectodal claims are made about such injections as creating youthfulness, adding permanent tissue volume and improving the appearance of the skin. This has led to a number of procedures being touted, particularly on the internet, with such names as stem cell facelifts and stem cell-enriched fat grafts. The names suggests that they are better than the traditional procedures.

But stem cell injections in plastic surgery today are, most of the time, fat injections that undoubtably contain stem cells but in what quantity and what activity is completely unknown. Although not cleared by the FDA for this use, there are machines available that can process fat to get a stem cell concentrate which can be injected. The problem with fat-derived stem cells is no one knows for sure what happens when they are injected or if there are any significant adverse effects long-term from doing so. It is reasonably assured that fat injections are completely harmless and that stem cell injections are similarly so, but that is a long way from being shown to be absolutely so.

Conversely, evidence that stem cell injections have any positive anti-aging effects by themselves has not yet been forthcoming. There is no doubt that the promise of stem cells is great in terms of potential tissue regeneration and some observable anti-aging effects on the skin. But there is very little data from human clinical studies that currently support any of the hype or marketing claims some doctors make. Injecting stem cells under the skin has not been proven to improve the appearance of the overlying skin. (fat injections are more promising based on the volume addition) The clinical results to date are isolated case presentations and subjective observations and substantial research is still needed to figure out the potential of stem cells. Thus for now, stem cell injections like stem cell containing skin serums, must be viewed as suspect.

Unlike stem cells, the positive effects of platelets on healing is more established. Wound healing is known to be mediated by a complex array of cellular and protein and peptide interactions. Platelets play a major role in this process. Platelet-rich plasma (PRP) is blood plasma that has a high concentration of platelets due to processing techniques. During the procedure, about 60cc of blood is removed from the patient and and the PRP concentrate is then obtained by a centrifugation process. This creates a few ccs of concentrated platelets (platelet plug) that can be added to a variety of plastic surgery procedures to theoretically improve their results. Due to its platelet contents, PRP contains many different growth factors and cytokines that have potent cellular and tissue stimulation effects.

While PRP can be used alone as an injection, its small quantity (usually about 3ccs) lends itself to be mixed or combined with other materials as part of the injectate. These could include fat or, more commonly, synthetic injectable fillers. There are several commercial aesthetic products which do just that with marketed brand names such as Selphyl and the Vampire Facelift. These products create either a platelet-rich fibrin matrix or are mixed or done right after the placement of such well known fillers as Juvederm and Restylane. The benefits of PRP in these facial rejuvenation techniques, while appealing, has not been fully substantiated in widespread clinical use and ongoing patient treatments continue to evaluate what role concentrated platelets may provide for volume retention and any other anti-aging benefits.

Stem cells and PRP are naturally derived products but that does not necessarily confer that more of them in one spot will be better than what we have residing in our bodies now. Their appeal is undeniable but that has not proven just yet that their benefits are equally so.

Dr. Barry Eppley

Indianapolis, Indiana

Topical Platelet-Rich Plasma (PRP and Facial Skin Rejuvenation)

Friday, March 15th, 2013

 

Just a few days ago, Kim Kardashian was in the news again with another plastic surgery adventure. This time it was about her receiving a so-called ‘blood facial’. Photos show her with blood apparently oozing or dripping from her face. A shockin as these pictures are, the ‘blood facial’ is not as gruesome as it appears to be but is actually based on well-known science and a recent method of promoting healing of various tissues throughout the body. Whether it is effective for facial rejuvenation and skin care is another matter…but more on that later.

The basis of the blood behind the ‘blood facial’  is known as PRP or platelet-rich plasma. This is an extract from whole blood which creates a concentrate of platelets. Platelets are well known to have high levels of grow factors which play a major role in how humans heal their own wounds. PRP is far from new and has been used extensively in medicine in every area of surgery, from orthopedics to podiatry. It has been used in plastic surgery from facelifts to tummy tucks to complicated wounds. I have mixed it for years in with fat when doing fat injections as a theoretical boost to fa tcell survival and stem cell conversion. There are now a variety of kits from numerous manufactureres to proces and prepare PRP for injection.

PRP is prepared by first taking a small amount of blood from the patient and using a centrifuge to separate into various layers. This creates a more solid layer of red and white blood cells and a plasma and platelet layer. It is the platelet plug and the plasma which makes the small but potent PRP material which is usually just a few ccs in volume. When loaded into a syringe it is ready for application.

While PRP is traditionally injected under the skin or mixed with other materials (e.g., fat) for injection, this is not how it was used in the Kim Kardashian story. In her case, it was dripped onto her face and then massaged ‘into’ her skin. While this sounds like it would be beneficial, this is a great example of what I call a ‘truism’.  It is assumed to be true because it just seems like it should. It sounds so logical that how it not be true? While PRP injected under the skin may stimulate collagen formation, that does not necessarily mean it would stimulate collagen growth in the skin when appled to it on the outside. Quite frankly, there is exactly zero scientific evidence that PRP has any skin benefits at all when applied topically. Some call topical PRP use controversial, but that would be an understatement. And just because a celebrity had the treatment done does not give it any more scientific credibility. (it makes for great TV and publicity however)

PRP has more credible uses for facial rejuvenation such as the interestingly named Vampire Facelift.  In this treatment, PRP is injected into the face in conjunction with collagen in a mixture known as Selphyl. It is purported to stimulate collagen growth and create a result that last up to two years after the injections. Patient results have been mixed but at least there is some theoretical science behind it…which is more than topical applied PRP can say.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review – Selphyl PRP Injectable Gel

Wednesday, October 3rd, 2012

 

Injectable fillers have achieved tremendous popularity and can be used for a wide variety of facial aesthetic needs. But most injectable fillers are merely temporary fillers that add volume and then disappears as the material absorbs. But a few contemporary fillers take a different approach, using natural materials whose intent is to stimulate local cellular and tissue growth which then creates the volumetric effect.

One of these autologous fillers is known as Selphyl. This is a unique system that creates a platelet-rich plasma (PRP) preparation from a small amount of blood. While PRP products are not new, what is unique about Selphyl is that it contains a fibrin matrix (Platelet-Rich Fibrin Matrix, PRFM) that wraps the platelets in its membrane allowing a sustained release of its growth factors after implantation. Such sustained release has the capability to promote the growth of new tissue through blood vessel and collagen stimulation, creating a natural tissue regeneration/augmentation.

The Selphyl system comes in a kit that allows the PRFM to be prepared in the office if necessary and takes about 30 minutes to do. Volumetric fill volumes are available in 4, 8 and 16ccs. It contains no synthetic or animal products, thus there is no chance of any allergic or immunologic reactions. While it is only FDA-approved for orthopedics, it is being widely used off-label in facial aesthetic applications for injection into wrinkles, folds, acne scars, hollows, tear troughs and in larger volumes for a ‘liquid facelift’. Best results are obtained with multiple injection treatments spaced four to six weeks apart, presumably due to the stimulation and build-up of collagen.

PRFM can be combined with other fillers, most notably fat. While theoretical, the introduction of stabilized platelets with fat and stem cells may allow more fat to survive or more stem cells to convert to fat cells.

Selphyl and its PRFM matrix is part of an evolving set of aesthetic treatments that are designed to stimulate collagen, improve the quality of the overlying skin and create an overall anti-aging effect. Patients are naturally attracted to an all-natural filler approach that employs local tissue regeneration to achieve the aesthetic goal.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma Facial Injections – Youth Serum?

Monday, August 27th, 2012

 

The search for a ‘magic serum’ that has the ability to rejuvenate the face and its overlying skin is both an unsolved hope and an endless quest. There are more topical creams and lotions that allege to create more youthful skin that one could ever purchase. But attention recently has turned to  injectable options to be placed under the skin. The use of synthetic injectable fillers has been around for more than ten years and their effects, profound as they may be, are not permanent and the evidence is weak that they cause any real skin changes.

Another injectable ‘rejuvenative serum’ is that of platelet-rich plasma. (PRP) Derived from the patient’s own blood, it can be defined as the portion of the plasma fraction of blood in which the level of platelets is higher than normal. This platelet concentrate results in high levels of a variety of growth factors from PDGF, FGF, EGF, VEGF and TGF-beta.  PRP has been studied extensively in wound healing and beneficial effects have been seen from chronic wounds to bone grafting. Such benefits in challenged wounds have logically raised the question of whether it would have rejuvenative effects in aging tissues.

There have been few well controlled clinical studies that have evaluated the effects of PRP on facial rejuvenation in an objective scientific manner.  In contrast, there is a large amount of marketing and hype that has surrounded such PRP facial injections. As with many aesthetic treatments largely driven by economic gain, marketing often gets way ahead of actual scientific proof. But of the handful of clinical aesthetic PRP injections, skin texture improvement and wrinkle reductions were seen and patient satisfaction with the treatments are usually more favorable than unfavorable. Despite reported patient satisfactions, I find that most of the before and after pictures of the patients in these clinical articles as underwhelming.

One highly important variable in any PRP treatment, aesthetic or otherwise, is dose. More specifically, what was the platelet concentration that was used and were the platelets truly viable? Most experimental studies have shown that it takes at least a 4X to 5X increase over one’s baseline platelet concentration to get a clinical response. Whatever devices that a clinician may use has to minimally obtain these concentrations to have any hope at being effective. The other important issue is that it likely takes a series of treatments, pulsed dosing if you will, to get a really significant clinical response. What that frequency should be and the practicality of it are unknown issues at present.

Because the effects of PRP may not be immediately evident (after the small amount of swelling subsides), some clinicians and manufacturers use a treatment approach that combined the PRP with either a collagen matrix or with off-the-shelf injectable fillers. Either approach makes more sense both biologically and clinically and is what I currently use in my practice.  There are advantages to either approach and it ultimately comes down to the cost of the adjunctive filler as well as the volume needed for the injection treatment. The filler provides the benefit of an immediate and sustained response by volumetric expansion.

The simplest and most inexpensive filler is to use the patient’s own fat as part of the PRP injectate. In this approach the PRP really becomes the adjunctive part and the fat is by volume the largest component. Despite the appeal of this approach, it has not yet been conclusively shown that it is better than fat injections alone. One experimental study has shown that there was no demonstrated improvement with PRP-fat mixtures. Based on the volume of PRP to fat, it seems more likely that it would be more effective in smaller volume facial fat injections that larger body procedures.

Is PRP the ‘magic serum’ that we seek for autologous aesthetic enhancements? The evidence to prove it and the best technique to achieve it remain elusive. But the appeal of PRP remains. In certain wounds, PRP has illustrated the ability of the body to ‘heal itself’. But in aesthetic improvements the ability to make yourself ‘grow younger’ has not yet been realized.

Dr. Barry Eppley

Indianapolis, Indiana

Injectable Facial Rejuvenation

Tuesday, July 10th, 2012

The desire to correct an aging facial appearance has been around as along as there is recorded history. Facelift surgery in various forms has been employed now for over one hundred years. Today’s facelift techniques are very diverse and use manipulations of all tissue levels down to the bone to achieve often dramatic improvements. Younger patients with very early signs of aging enjoy the benefits of facelifting albeit with more limited procedures geared towards the need for less dramatic changes.

But no matter how it is done, a facelift procedure is invasive and many patients want to avoid surgery if at all possible. Some patients are so opposed to surgery that they will choose any procedure  that simply isn’t surgery. With the widespread and growing use of injectable fillers and promising autologous therapies like platelet-rich plasma (PRP) and stem cells, newer methods of ‘non-surgical facelifts’ have emerged. Some of these have very catchy names and good marketing efforts behind them, which combined with the ability to do them outside of a traditional operating room setting, has caught the attention and imagination of people concerned about their aging facial appearance.

The basic concept of all of these techniques is that they are injectable. While the name ‘facelift’ has become attached them, this is not an accurate name for them. They do not achieve the same effect as a facelift nor should they be construed as having much other similarity to a facelift either. Their use of the facelift name is a marketing manuever. The only similarity between a true facelift and these injection techniques is that they treat the same problem…facial aging concerns. Therefore, the proper name for them should be Injectable Facial Rejuvenation (IFR) which signifies their non-surgical nature They may provide some degree of rejuvenation but they definitely don’t lift tissues in the conventional sense.

In reviewing the available options for Injectable Facial Rejuvenation, it is important to recognize that most of them are not standardized treatment methods and are not sanctioned by the FDA to be used in this fashion. Because these techniques have emerged largely from marketing and patient recruitment means, and not from scientific or clinical studies, there is no way to compare their effectiveness other than anectodal reports and patient testimonials. This is why how one practitioner performs one injectable technique may be different than another. Such provider variability makes it impossible to assess the effectiveness of one IFR method, let alone if one IFR method is more effective than another.

The Liquid Facelift uses either one or a variety of off-the-shelf FDA-approved injectable fillers. These could include any of the many hyaluronic-acid based fillers, such as Restylane or Juvederm, or the particulated fillers such as Sculptra or Radiesse. The concept is the select placement of them into volume-deficient or sagging facial areas that expands them, thus creating some degree of a lifting effect. This is more expansion than a lifting result. Its effects will subside as the filler absorbs. It is postulated but not proven that these fillers have a long-term collagen stimulatory effect.

The Vampire Facelift is the ultimate marketer in IFR because it is a company that sells its technique for use. Its foundation is the use of platelet-rich plasma (PRP), an autologous platelet concentrate extract which contains growth factors and cytokines. Such factors have proven laboratory performance of accelerated healing. When introduced under the skin, it is presumed that it may have some rejuvenative or stimulatory properties. This technique is also combined with injectable fillers. The theory is that the PRP and the fillers in combination may lead to an enhanced and sustained collagen response. Whether this is enough to wake up the living dead is speculative.

The Stem Cell Facelift primarily employs the injection of fat or allegedly concentrated extracts of stem cells. Stem cells have caught the imagination of the cosmetic surgery world with the belief that they will provide some rejuvenative effect. This concept is theoretically appealing but has little scientific proof that this really occurs. Most ‘stem cell extracts’ are just concentrated fat from liposuction harvests. As such, it is impossible to know how many stem cells and what their potential is in any fat concentrate. Because of the widespread uncertainty of the value and effectiveness of stem cells, the American Society of Plastic Surgeons has issued a position statement that any of its members promoting or marketing stem cell techniques as unethical behavior. In addition, the FDA has recently issued a ban on any company that grows patient stem cells for treatment. All stem cell therapies, even using the patient’s own stem cells, must be done under a clinical study protocol. This does not exclude the common use of fat injections in which stem cells exist amongst the fat cells and are incidentally injected. But promoting it as a stem cell procedure is not viewed favorably.

The Acupuncture Facelift employs the traditional Chinese technique of the introduction of needles to free up chi or energy. Allegedly, introducing needles into the face causes the production of collagen and elastin to plump up the skin. After a series of 10 treatments, wrinkles and deeper lines are purportedly reduced and skin is lifted. More likely, some mild swelling occurs as a result of the needles and results in some slight temporary skin fullness but no documented and proven lifting effect that is sustained as ever been studied or proven. This limited injection or needle approach to facial rejuvenation is the greatest stretch in calling it a facelift technique.

Injectable Facial Rejuvenation has a role to play in treating facial aging concerns but should be understood in proper context. They are not facelifts and will not lift up sagging facial tissues. They are principally plumpers or volumizers and achieve any wrinkle or fold reduction through this effect.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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