As a cosmetic and oculoplastic surgeon I tend to focus on the tolerability of aesthetic procedures. Patients desire noticeable results with the least possible downtime. With ablative laser skin resurfacing, those expectations can be difficult to meet. The carbon dioxide laser is the gold standard for skin rejuvenation, wrinkle reduction and sun damage improvement. Traditionally, a full surface ablation was performed into the level of the dermis, leaving patients with a confluent depithelialized wound over the entire face. The results were fantastic but the incidence of infection and hypopigmentation was significant. These patients wore occlusive dressings and had a burn-like appearance for 2-3 weeks. They essentially had to go into hiding during this time because of the prolonged healing phase.
Fractional devices were a major advance. Instead of a contiguous ablation zone, parcels of skin were injured but small spots of intervening normal skin was left untouched. Re-epithelialization could occur more rapidly from these normal skin islands and the results were almost as favorable as traditional ablation. Patients were able to return to normal life in 5-7 days instead of a number of weeks and complications were reduced. But the typical aesthetic patient has an active, busy lifestyle and even 1 week trapped at home can seem burdensome.
There are a number of post-laser topical agents available on the market to improve healing after resurfacing. I have offered a number of these to my patients with mixed results. The main concerns were that they were too greasy, comedogenic, or too expensive.
Platelet- rich plasma has earned considerable attention in aesthetic medicine in recent years. Intuitively it makes sense to use the body’s innate system of growth factors to enhance and modulate cell activity in a targeted manner. At a conference in Korea I learned of mesotherapy-style PRP treatments as a minimally invasive means of skin rejuvenation. Injections into the dermis were shown to increase type-1 collagen and fibroblast proliferation by Kim DH et al. in Annals of Dermatology, implying that PRP can potentially restore dermal components that degrade with aging and photodamage. This so-called “vampire facelift” has gained some popularity among patients who desire a non-synthetic, rejuvenative facial injectable treatment.
The wound healing effects of PRP have also been well documented. Recently, a split-face study by Lee JW et al. published in Dermatologic Surgery demonstrated that PRP reduced healing time by 1 day after fractional carbon dioxide resurfacing of the face. The PRP-treated side had less redness than controls and biopsies showed more collagen. I decided to incorporate PRP in my fractional laser skin resurfacing procedures after reviewing the scientific literature. The benefits were well substantiated, it is easy to obtain and prepare with a blood draw and a centrifuge, and it is easy to administer.
I use the Lumenis Encore laser with the ActiveFX and DeepFX fractional protocols. The Encore is an ultrapulsed carbon dioxide laser that creates a 1.3 mm spot size with the ActiveFX handpiece and a 0.12 spot size with the DeepFX handpiece. ActiveFX is a relatively superficial ablation that reduces fine lines and brown spots while DeepFX penetrates deeper into the dermis to improve deep wrinkles. I think of these deep ablation channels as access tunnels for PRP to enter the dermis, similar to how some clinicians have used needle rollers to create hundreds of skin microperforations before applying topical PRP. Immediately after full-face laser resurfacing, approximately 2 milliliters (concentrated from 40 milliliters of blood) is applied to the skin surface.
Subjectively, the results are promising. After fractional resurfacing, full re-epithelialization usually occurs at 6-7 days, depending on the laser settings. With the single post-laser PRP treatment, recovery appears to proceed more rapidly. The photo below demonstrates a patient with severe photodamaged skin before resurfacing (left) and 5 days after superficial and deep fractional carbon dioxide laser resurfacing with topically applied PRP (right). Full epitheliaziation is present with some mild erythema and edema. The small brown dots at the periphery represent residual devitalized skin that has not yet sloughed.
I expect the cosmetic applications of PRP will become more widespread and more clearly defined in coming years. There is a demand for non-synthetic rejuvenative treatments and PRP nicely fits that category.
Brett Kotlus, M.D. is a cosmetic and oculofacial surgeon practicing in Michigan. He is the author of Boost Your Beauty, a cosmetic guide to modern cosmetic treatments. Check out his website here.
