Loose, Saggy Skin; Skin That’s Lost its Suppleness and “Bounce”

Skin laxity and sagging affects us all, albeit to variable degrees and at different rates. It is dependent on multiple factors such as: the ageing process (our cells replenish less and less collagen and elastin with time), the effects of chronic sun exposure (UV radiation gradually destroys what collagen and elastin we have) and on genetic factors (which determine our collagen and elastin synthesis). And of course there would be no sag without the effect of gravity!

Every part of the body’s skin can sag but it is most noticeable where the skin is thinner such as around the eyes, on the neck and the inner arms. Sagging skin is also more noticeable where fat deposits have thinned after weight loss, for example in the jowls and abdomen.

Platelet Rich Plasma (PRP) is an effective rejuvenation treatment to reverse some of these effects on the skin’s collagen and elastin. PRP can be injected into the skin anywhere on the body, but most often it is used to rejuvenate more cosmetically sensitive areas such as the face, neck, chest and hands. The procedure involves concentrating platelets from the patient’s own blood. They are then activated to release multiple growth factors which stimulate the skin stem cells to produce collagen and to regenerate the skin.

Blood is collected in special tubes similar to those used for a blood test. 10mls of blood is put into each test tube vial and the number of vials used depends on the size of the area to be treated. 10mls of whole blood yields 6mls of plasma (containing the concentrated platelets). This is the clear yellow part of the blood which is separated from the red blood cells by centrifugation or spinning of the tube for 5mins. 2 tubes of plasma (12mls) would adequately treat sagging jowls and crepey skin around the eyes.

EMLA is a numbing cream applied to the areas of skin to be treated to aid in the comfort of the procedure. This can take 45mins to become effective, during which time the blood is taken, separated into plasma, siphoned into syringes and activated with liquid calcium gluconate. The areas of the skin to be treated are marked out and the PRP is then injected into the dermis of the skin and just below the dermis using fine needles. Sometimes multiple punctures in the skin are necessary to inject fine threads of the plasma, sometimes there are fewer injections points given as boluses. The areas injected become swollen with the fluid, redness occurs and more tissue swelling is expected over the next few hours as the inflammatory process is triggered. This will settle down in the next 2-3 days particularly with regular application of ice. Bleeding, bruising and tenderness caused by the trauma of the needles also occurs to a certain extent, but will heal within a week. Creams to dissolve bruises should be used, plus makeup can be applied the next day.

Visible results are noticed in the skin after a couple of weeks as the collagen starts to grow. Maximum collagen stimulation occurs at around 12 weeks, and can continue to improve for up to several months. The skin starts to feel firmer and thicker and look more taught. Fine lines soften and may disappear. The skin on the hands can be seen to bounce back into shape faster after being pinched. Multiple treatments may be necessary to achieve the desired effect especially when there is more skin laxity. Not everyone responds to PRP in the same way either. Some of the results can be unpredictable. Less improvement is certainly noticed in smokers, those who have blood disorders or infections, and in older patients who probably have fewer stem cells in the skin to do the job.

How long this rejuvenation of the skin lasts depends on our innate ageing process and how well we look after our skin. Continued sun exposure will necessitate the need for more frequent maintenance treatments, but yearly PRP treatments are usually recommended to maintain optimum results.

The above is a guest post by cosmetic physician Dr. Csilla S. Novak, M.B.B.S.