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PRP & Fat Grafting: Autologous materials for rejuvenation Kseniya Kobets, MD, MHS Skin Laser & Surgery Specialists of NY and NJ NFCM 2019 PLATELETS AND FAT TRANSFER Platelet Rich Plasma (PRP) • Rejuvenation • Post-procedure treatment Hair loss treatment PRP side effects Autologous Fat Transfer • Volumization • Rejuvenation Advantages over fillers PRP + Fat 101 ON PRP: Platelet-rich plasma (PRP): since the 1970’s a variety of different methods have been used to prepare PRP, leading to significant variation in the composition and outcomes Landau MJ, Birnbaum ZE, Kurtz LG, Aronowitz JA. Review: Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting. Plast Reconstr Surg Glob Open. 2018 Aug 3;6(8):e1870. doi: 10.1097/GOX.0000000000001870. eCollection 2018 Aug. PubMed PMID: 30324057; PubMed Central PMCID: PMC6181489. 1 2 3

PRP & Fat Grafting: Autologous materials for rejuvenation€¦ · • Rejuvenation • Advantages over fillers •PRP + Fat 101 ON PRP: • Platelet-rich plasma (PRP): • since the

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Page 1: PRP & Fat Grafting: Autologous materials for rejuvenation€¦ · • Rejuvenation • Advantages over fillers •PRP + Fat 101 ON PRP: • Platelet-rich plasma (PRP): • since the

P R P & F a t G r a f t i n g :A u t o l o g o u s m a t e r i a l s

f o r r e j u v e n a t i o nK s e n i y a K o b e t s , M D, M H S

S k i n L a s e r & S u r g e r y S p e c i a l i s t s o f N Y a n d N J

N F C M 2 0 1 9

PLATELETS AND FAT TRANSFER

Platelet Rich Plasma (PRP)

• Rejuvenation• Post-procedure

treatment• Hair loss treatment• PRP side effects

Autologous Fat Transfer

• Volumization• Rejuvenation• Advantages over fillers• PRP + Fat

101 ON PRP:• Platelet-rich plasma (PRP):

• since the 1970’s a variety of different methods have been used to prepare PRP, leading to significant variation in the composition and outcomes

Landau MJ, Birnbaum ZE, Kurtz LG, Aronowitz JA. Review: Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting. Plast Reconstr Surg Glob Open. 2018 Aug 3;6(8):e1870. doi: 10.1097/GOX.0000000000001870. eCollection 2018 Aug. PubMed PMID: 30324057; PubMed Central PMCID: PMC6181489.

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101 ON PRP:• Platelet-rich plasma (PRP):

• Platelets have healing proteins called growth factors

• Growth factors accelerate tissue and wound healing, and anti-inflammatory

• PRP has high concentration of growth factors

• Used over 20 years in diverse medical and surgical procedures, especially in the fields of wound healing, orthopedic surgery, periodontic surgery, maxillofacial surgery, plastic surgery, thoracic surgery, and ophthalmology

Maisel-Campbell AL, Ismail A, Reynolds KA, Poon E, Serrano L, Grushchak S, Farid C, West DP, Alam M. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res. 2019 Oct 18. doi: 10.1007/s00403-019-01999-6. [Epub ahead of print] Review. PubMed PMID: 31628542.

101 ON PRP:• hair restoration

• skin rejuvenation

• acne scars

• dermal augmentation

• striae distensae

• combining PRP with:

– laser therapies

– microneedling

– dermal fillers

– autologous fat grafting

Emer J. Platelet-Rich Plasma (PRP): Current Applications in Dermatology. Skin Therapy Lett. 2019 Sep;24(5):1-6. PubMed PMID: 31584784.

101 ON PRP:• Platelet-rich plasma (PRP):

• autologous solution

• supraphysiologic concentrations of platelets (greater than 1 × 106/μL) in plasma

• includes over 800 bioactive molecules (mitogenic and chemotactic growth factors)

• Released from the alpha granules of activated platelets:

– platelet-derived growth factors (PDGF)

– transforming growth factor-β1 (TGF-β1)

– TGF-β2

– vascular endothelial growth factor (VEGF)

– basic fibroblast growth factor (bFGF)

– epithelial growth factor (EGF)

Maisel-Campbell AL, Ismail A, Reynolds KA, Poon E, Serrano L, Grushchak S, Farid C, West DP, Alam M. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res. 2019 Oct 18. doi: 10.1007/s00403-019-01999-6. [Epub ahead of print] Review. PubMed PMID: 31628542.

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• cytokines play important roles in cell proliferation, chemotaxis, cell differentiation, and angiogenesis

• platelets in PRP are delivered to the site of a clot, which contains several cell adhesion molecules including fibronectin, fibrin, and vitronectin

• these cell adhesion molecules aid in cell migration by acting as scaffolding upon which cells adhere and begin the wound healing process

Alam M, Hughart R, Champlain A, Geisler A, Paghdal K, Whiting D, Hammel JA, Maisel A, Rapcan MJ, West DP, Poon E. Effect of Platelet-Rich Plasma Injection for Rejuvenation of Photoaged Facial Skin: A Randomized Clinical Trial. JAMA Dermatol. 2018 Dec 1;154(12):1447-1452. doi: 10.1001/jamadermatol.2018.3977. PubMed PMID: 30419125; PubMed Central PMCID: PMC6583756Image: https://www.thehartlandclinic.co.uk/platelet-rich-plasma-prp-injections-in-oxfordshire/

PRP Anticoagulation

Preparation of PRP begins by addition of citrate to whole blood to bind the ionized calcium and inhibit the clotting cascade:

Anticoagulants

• SC Sodium citrate *

• CPD citrate–phosphate–dextrose–adenine (used when collecting for blood transfusion)

• ACD acid citrate dextrose

• EDTA

• heparin

* do Amaral RJ, da Silva NP, Haddad NF, Lopes LS, Ferreira FD, Filho RB, Cappelletti PA, de Mello W, Cordeiro-Spinetti E, Balduino A. Platelet-Rich Plasma Obtained with Different Anticoagulants and Their Effect on Platelet Numbers and Mesenchymal Stromal Cells Behavior In Vitro. Stem Cells Int. 2016;2016:7414036. doi: 10.1155/2016/7414036. Epub 2016 Jun 2. PubMed PMID: 27340410; PubMed Central PMCID: PMC4909912.

PRP ActivationActivators:

• CaCl2 calcium chloride

• CaG calcium gluconate

• PRGF platelet-rich growth factor

• Endogenous activation by injection

• In 16 studies (67%), PRP was exogenously activated, commonly with calcium chloride

• active secretion of these growth factors by platelets begins within 10 min after activation, with more than 95% of the pre-synthesized growth factors secreted within 1 hour

• do Amaral RJ, da Silva NP, Haddad NF, Lopes LS, Ferreira FD, Filho RB, Cappelletti PA, de Mello W, Cordeiro-Spinetti E, Balduino A. Platelet-Rich Plasma Obtained with Different Anticoagulants and Their Effect on Platelet Numbers and Mesenchymal Stromal Cells Behavior In Vitro. Stem Cells Int. 2016;2016:7414036. doi: 10.1155/2016/7414036. Epub 2016 Jun 2. PubMed PMID: 27340410; PubMed Central PMCID: PMC4909912.

• Image: Platelet-rich plasma, an adjuvant biological therapy to assist peripheral nerve repairSánchez Mikel, Garate Ane, Delgado Diego, Padilla Sabino. Year : 2017 | Volume: 12 | Issue Number: Page: 47-52

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PRP PREPARATION

• First spin isolates the PPP

• Second spin discards both the RBC layer and the platelet-poor plasma (PPP)

• Depending on when platelets get activated, may not want to discard the top potion since growth factors can float to surface

Alam M, Hughart R, Champlain A, Geisler A, Paghdal K, Whiting D, Hammel JA, Maisel A, Rapcan MJ, West DP, Poon E. Effect of Platelet-Rich Plasma Injection for Rejuvenation of Photoaged Facial Skin: A Randomized Clinical Trial. JAMA Dermatol. 2018 Dec 1;154(12):1447-1452. doi: 10.1001/jamadermatol.2018.3977. PubMed PMID: 30419125; PubMed Central PMCID: PMC6583756Kececi Y, Ozsu S, Bilgir O. A cost-effective method for obtaining standard platelet-rich plasma. Wounds. 2014 Aug;26(8):232-8. PubMed PMID: 25860639.

Recent Cochrane review

• October 2019 reviewed 24 studies

• Heterogeneity of PRP preparation and administration

• Lack of standardization of outcome measures

• PRP is mostly safe

• PRP is modestly beneficial for aging skin

• PRP most convincing for facial skin texture, but unknown persistence of effects

Maisel-Campbell AL, Ismail A, Reynolds KA, Poon E, Serrano L, Grushchak S, Farid C, West DP, Alam M. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res. 2019 Oct 18. doi: 10.1007/s00403-019-01999-6. [Epub ahead of print] Review. PubMed PMID: 31628542.

PRP with fractional laser resurfacing for skin rejuvenation

• Fractional CO2 (N = 3) or Er:Glass (N = 1)

• PRP significantly decreased the intensity and duration of laser-associated side effects, including erythema, edema, dyspigmentation, and crusting

• Two studies reported incremental clinical improvement in skin elasticity with PRP injections and fractional laser treatment, as versus fractional laser alone

Hui Q, Chang P, Guo B, Zhang Y, Tao K. The Clinical Efficacy of Autologous Platelet-Rich Plasma Combined with Ultra-Pulsed Fractional CO(2) Laser Therapy for Facial Rejuvenation. Rejuvenation Res. 2017 Feb;20(1):25-31. doi: 10.1089/rej.2016.1823. Epub 2016 Jun 23. PubMed PMID: 27222038; PubMed Central PMCID: PMC5314998.

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PRP monotherapy

• 9 studies injected PRP

• one study applied PRP topically with microneedeling

• in 6 studies, some degree of physician-rated global improvement was seen in 75–100% of patients

• in 8 studies, 3 treatment showed 90% patient satisfaction

• 67% achieved up to 50% improvement

• 33% achieved > 50% improvement

• skin elasticity, texture, hydration, wrinkles, and micropigmentation improved

Maisel-Campbell AL, Ismail A, Reynolds KA, Poon E, Serrano L, Grushchak S, Farid C, West DP, Alam M. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res. 2019 Oct 18. doi: 10.1007/s00403-019-01999-6. [Epub ahead of print] Review. PubMed PMID: 31628542.

PRP WITH SUBCISION FOR ACNE SCARS

PRP WITH SUBCISIONFOR ACNE SCARS

• PRP + subcision decreases rolling scars

• PRP + subcision decreases box scars

• Better than subcision alone

• No effect on ice-pick scars

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PRP AND HAIR RESTORATION

PRP growth factors promote hair regrowth by:

• stimulating stem cell differentiation of hair follicles

• inducing and prolonging the proliferative anagen phase of hair follicles

• activating anti-apoptotic pathways

• promoting angiogenesis to increase perifollicular vascularization and the survival of dermal papilla fibroblasts

Emer J. Platelet-Rich Plasma (PRP): Current Applications in Dermatology. Skin Therapy Lett. 2019 Sep;24(5):1-6. PubMed PMID: 31584784.

PRP 2 sessions: Telogen effluvium

Photos: Courtesy of Kseniya Kobets, MD

PRP 2 sessions: Telogen effluvium

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PRP: Androgenetic alopecia

Photos: Emer J. Platelet-Rich Plasma (PRP): Current Applications in Dermatology. Skin Therapy Lett. 2019 Sep;24(5):1-6. PubMed PMID: 31584784.

• start with a series of monthly

injections until improvement

• maintenance therapies every 2

to 3 months indefinitely

• combining with finasteride

(male patients), minoxidil, low-

level light therapy, and

spironolactone (female

patients), may inc efficacy

PRP and Alopecia areata (AA)

• Key principle of AA treatment:– is to halt the immune process

– activate the bulge melanocyte pre- cursors to proliferate, differentiate to form new bulbs in anagen phase

– it is unknown if it is the cessation of inflammation that leads to spontaneous activation of regenerative pathways, or if direct stimulation of these pathways by drugs is playing an active role in successful in hair regrowth

Barbulescu CC, Goldstein NB, Roop DR, Norris DA, Birlea SA. Harnessing the Power of Regenerative Therapy for Vitiligo and Alopecia Areata. J InvestDermatol. 2019 Jun 10. pii: S0022-202X(19)31465-4. doi: 10.1016/j.jid.2019.03.1142. [Epub ahead of print] Review. PubMed PMID: 3119675

PRP AND ALOPECIA AREATA

Barbulescu CC, Goldstein NB, Roop DR, Norris DA, Birlea SA. Harnessing the Power of Regenerative Therapy for Vitiligo and Alopecia Areata. J InvestDermatol. 2019 Jun 10. pii: S0022-202X(19)31465-4. doi: 10.1016/j.jid.2019.03.1142. [Epub ahead of print] Review. PubMed PMID: 3119675

• PRP encourages the telogen-to-anagen transition

– platelet- derived growth factor, TGF-b, vascular endothelial growth factor, IGF, and FGF) by direct stimulation of the DP

• indirect activation of Wnt and growth factor pathways, and prevention of apoptosis

• activation of Wnt and growth factor pathways is mediated by stimulation of b-catenin and extracellular-signal-regulated kinase signaling, which leads to melanocyte and keratinocyte proliferation, differentiation, and survival

• PRP prolongs the duration of anagen via IGF-1/2, FGF7, and platelet-derived growth factor activation

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PRP AND ALOPECIA AREATA

l Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther. 2017 Jan;30(1). doi: 10.1111/dth.12437. Epub 2016 Oct 28. PubMed PMID:

27791311

• Minoxidil 5% vs PRP for 3 months

• PRP earlier and better response

• Best responses with patchy alopecia areata

• Less effective in alopecia universalis

• Not effective in alopecia totalis

• PRP injections not covered by insurance

AUTOLOGOUS FAT TRANSFER• Approximately 18 years ago, an

important scientific advance was made by researchers in finding that adipose tissue (fat) contained high numbers of stem cells

• Fat is largest microvascular organ in the body

• Stromal vascular fraction

Alexander RW. Biocellular Regenerative Medicine: Use of Adipose-Derived Stem/Stromal Cells and It's Native Bioactive Matrix. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):871-891. doi: 10.1016/j.pmr.2016.06.005. Review. PubMed PMID: 27788905.

Adipose-derived tissue stromal vascular fraction • Hematopoietic stem cells

• Host site interaction with these cells, is site specific in many of their responses

• Multipotent capabilities of AD–tissue stromal vascular fraction (tSVF)

• Capabilities of differentiation to a variety of tissues, including bone, cartilage, tendon-ligament, muscle, fat, nerve, etc

Alexander RW. Biocellular Regenerative Medicine: Use of Adipose-Derived Stem/Stromal Cells and It's Native Bioactive Matrix. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):871-891. doi: 10.1016/j.pmr.2016.06.005. Review. PubMed PMID: 27788905.

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AUTOLOGOUS FAT TRANSFER

• Inconsistent and unpredictable graft survival results in past

• PRP added to autologous fat transfer to increase

Alexander RW. Biocellular Regenerative Medicine: Use of Adipose-Derived Stem/Stromal Cells and It's Native Bioactive Matrix. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):871-891. doi: 10.1016/j.pmr.2016.06.005. Review. PubMed PMID: 27788905.

PRP in facial and body lipofilling

Kevin S. Sadati, DO, Anthony C. Corrado, DO, Robert W. Alexander, MD, DMD. Platelet-Rich Plasma (PRP) Utilized to Promote Greater Graft Volume Retention in Autologous Fat Grafting First Published December 1, 2006 Research Article https://doi.org/10.1177/074880680602300407. Volume: 23 issue: 4, page(s): 203-211

PRP in facial and body lipofilling

Kevin S. Sadati, DO, Anthony C. Corrado, DO, Robert W. Alexander, MD, DMD. Platelet-Rich Plasma (PRP) Utilized to Promote Greater Graft Volume Retention in Autologous Fat Grafting First Published December 1, 2006 Research Article https://doi.org/10.1177/074880680602300407. Volume: 23 issue: 4, page(s): 203-211

Theoretically PRP can:

• create favorable microenvironment of growth factors

• improve survival of fat grafted

• preferred by surgeons and patients when compared to non-PRP fat transfer

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PRP in facial lipofilling

• One RCT investigated adding PRP to facial lipofilling in the temporal and midface areas1

• PRP significantly reduced postoperative recovery time (mean 15.4 days versus 9.1 days)

1. Willemsen JCN, Van Dongen J, Spiekman M, Vermeulen KM, Harmsen MC, van der Lei B, Stevens HPJ. The Addition of Platelet-Rich Plasma to Facial Lipofilling: ADouble-Blind, Placebo-Controlled, Randomized Trial. Plast Reconstr Surg. 2018 Feb;141(2):331-343. doi: 10.1097/PRS.0000000000004081. PubMed PMID: 29019860.2. Maisel-Campbell AL, Ismail A, Reynolds KA, Poon E, Serrano L, Grushchak S, Farid C, West DP, Alam M. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res. 2019 Oct 18. doi: 10.1007/s00403-019-01999-6. [Epub ahead of print] Review. PubMed PMID: 31628542.

PRP in facial lipofilling• PRP significantly reduced

postoperative recovery time (mean 15.4 days versus 9.1 days)

• PRP did NOT improve skin elasticity or increase volume in this study

• However, the volume of PRP relative to fat mass may have affected results of volume retention

1. Willemsen JCN, Van Dongen J, Spiekman M, Vermeulen KM, Harmsen MC, van der Lei B, Stevens HPJ. The Addition of Platelet-Rich Plasma to Facial Lipofilling: ADouble-Blind, Placebo-Controlled, Randomized Trial. Plast Reconstr Surg. 2018 Feb;141(2):331-343. doi: 10.1097/PRS.0000000000004081. PubMed PMID: 29019860.2. Maisel-Campbell AL, Ismail A, Reynolds KA, Poon E, Serrano L, Grushchak S, Farid C, West DP, Alam M. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res. 2019 Oct 18. doi: 10.1007/s00403-019-01999-6. [Epub ahead of print] Review. PubMed PMID: 31628542.

PRP INCREASES FAT GRAFT RETENTION

Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Curcio CB, Floris M, Fiaschetti V, Floris R, Cervell V. A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction. Stem Cells Transl Med. 2012 Apr;1(4):341-51. doi: 10.5966/sctm.2011-0065. Epub 2012 Apr 13. PubMed PMID: 23197813; PubMed Central PMCID: PMC3659694.

• Stem cells from SVF or PRP mixed with fat

• 0.4mL PRP for every 1mL fat• Improved volume retention

compared to control

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PROCESSED FAT

Understanding Mechanical Emulsification (Nanofat) Versus Enzymatic Isolation of Tissue Stromal Vascular Fraction (tSVF) Cells from Adipose Tissue

• Macrofat

• Microfat

• Nanofat

• Rejenerative medicine

• Antiaging

• Hair restoration

Stem cells turn to fibroblasts or fat cells in culture

• Macrofat fibroblasts, fat lobules

• Microfat fibroblasts, fat lobules

• Nanofat fibroblasts, fat lobules

MICROFAT AND NANOFAT

• 67 cases to correct superficial rhytides, scars, and dark lower eyelids

• Improvement in skin quality 6 months post-op

• Dr. Tonnard was the first to describe in 2013 nanofat injection with 27G needle

Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg. 2013 Oct;132(4):1017-26. doi: 10.1097/PRS.0b013e31829fe1b0. PubMed PMID: 23783059.

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SHARP-NEEDLE INTRADERMAL FAT GRAFTING (SNIF)

Zeltzer AA, Tonnard PL, Verpaele AM. Sharp-needle intradermal fat grafting (SNIF). AesthetSurg J. 2012 Jul;32(5):554-61. doi: 10.1177/1090820X12445082. PubMed PMID: 22745443.

• 23-27G needle or cannula

NanofatMicroneedeling

• 1.5mm microneedeling

• Reaches papillary dermis

• Downtime of 48 hrs of erythema and petechiae

• Final results 6-8 months

Verpaele A, Tonnard P, Jeganathan C, Ramaut L. Nanofat Needling: A Novel Method for Uniform Delivery of Adipose-Derived Stromal Vascular Fraction into the Skin. Plast Reconstr Surg. 2019 Apr;143(4):1062-1065. doi: 10.1097/PRS.0000000000005455. Erratum in: Plast Reconstr Surg. 2019 Jul;144(1):264. PubMed PMID: 30921122.

NanofatMicroneedeling

Verpaele A, Tonnard P, Jeganathan C, Ramaut L. Nanofat Needling: A Novel Method for Uniform Delivery of Adipose-Derived Stromal Vascular Fraction into the Skin. Plast Reconstr Surg. 2019 Apr;143(4):1062-1065. doi: 10.1097/PRS.0000000000005455. Erratum in: Plast Reconstr Surg. 2019 Jul;144(1):264. PubMed PMID: 30921122.

BEFORE 6mos AFTER

• Downtime of 48 hrs of erythema and petechiae

• Easily coverable by makeup• Final results 6-8 months

• More studies needed• Less invasive than injection

or laser resurfacing

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SAFETY WITH PRP

• According to the International Cellular Medicine Society, the main contraindications of PRP are:

– platelet dysfunction syndrome

– critical thrombocytopenia

– hemodynamic instability

– Septicemia

– local infection at the treating site

– patient unwilling to accept the risks of the treatment

Owczarczyk-Saczonek A, Wygonowska E, Budkiewicz M, Placek W. Serum sickness disease in a patient with alopecia areata and Meniere' disease after PRP procedure. Dermatol Ther. 2019 Mar;32(2):e12798. doi: 10.1111/dth.12798. Epub 2019 Jan 8. PubMed PMID: 30511475.

SAFETY WITH PRP

PRP relatively safe procedure, or is it?

• Kalvam et al reported: – Irreversible blindness following bilateral cosmetic platelet-

rich plasma injections to rhytids in the glabellar region

– External exam showed skin necrosis in the region over the right rhytids and restricted right ocular motility

Kalyam K, Kavoussi SC, Ehrlich M, Teng CC, Chadha N, Khodadadeh S, Liu J.Irreversible Blindness Following Periocular Autologous Platelet-Rich Plasma Skin Rejuvenation Treatment. Ophthalmic Plast Reconstr Surg. 2017 May/Jun;33(3S Suppl 1):S12-S16. doi: 10.1097/IOP.0000000000000680. PubMed PMID: 27015236.

SAFETY WITH PRP

PRP relatively safe procedure, or is it?

• Stojadinovic et al. reported after PRP + microneedling to scalp:– scalp pruritis with PRP + microneedling with Eclipse ® pen

– plus cases of shedding that resolved in 6-8 weeks

– and lymphadenopathy in 4 subjects 1-3 d post, resolved spontaneously

Stojadinovic O, Morrison B, Tosti A. Side effects of Platelet Rich Plasma and Microneedeling. J Am Acad Dermatol. 2019 Aug 10. pii: S0190-9622(19)32554-X. doi:10.1016/j.jaad.2019.07.109. [Epub ahead of print] PubMed PMID: 31408684.

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SAFETY WITH PRPPRP relatively safe procedure, or is it?

Owczarczyk-Saczonek et al reported:

• Serum sickness after PRP injection 2 weeks after 3rd injection

• Erythematous wheals with arthralgia, malaise, fatigue, and fever

• Improved with higher level prednisone

Owczarczyk-Saczonek A, Wygonowska E, Budkiewicz M, Placek W. Serum sickness disease in a patient with alopecia areata and Meniere' disease after PRP procedure. Dermatol Ther. 2019 Mar;32(2):e12798. doi: 10.1111/dth.12798. Epub 2019 Jan 8. PubMed PMID: 30511475.

SAFETY WITH PRP• Patient also observed a new lesion of alopecia

for 5 months

• 4 months later, she had severe symptoms of Menier's disease and episode of sudden sensorineural hearing loss (as the immune-mediated inner ear disease)

• Alleviated only after intravenous administration of methylprednisolone

• After treatment she has severe hearing impairment of right ear

• Avoid PRP in active autoimmune dz?

Owczarczyk-Saczonek A, Wygonowska E, Budkiewicz M, Placek W. Serum sickness disease in a patient with alopecia areata and Meniere' disease after PRP procedure. Dermatol Ther. 2019 Mar;32(2):e12798. doi: 10.1111/dth.12798. Epub 2019 Jan 8. PubMed PMID: 30511475.

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