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Combination treatments with platelet-rich plasma in cosmetic dermatology

Platelet-rich plasma (PRP) treatment is a plasma component that has a higher platelet concentration after centrifugation of autologous blood placed in a citrated blood tube, which has become increasingly popular and widely used in recent years. The purpose of the use of PRP is to accelerate tissue repair, directly and indirectly, by decreasing the amount of erythrocytes and increasing the number of platelets, increasing the release of growth factor at supraphysiological concentrations. For the clinical effect of PRP, its regenerative effect on the wound is mentioned when it is at least 4 times higher than the basal value (150 000-400 000/μl), that is, 1 000 000/μl.1-4 Cell regulation, differentiation of growth factors in the wound healing process, Having important roles in proliferation, chemotaxis, angiogenesis, and matrix synthesis processes proves that PRP, which is rich in growth factors, can be used in this process.5-8 PRP’s fibroblast proliferation, which is necessary in the wound healing process, Matrix metalloproteinase (MMP) ) 1-3, and an increase in type 1 collagen has been proven to increase the synthesis of the extracellular matrix (ECM). -13 If the timing of PRP is evaluated; The bioactivity of the concentrated platelets in PRP continues for 6 hours and PRP needs to be injected within 3 hours. In PRP activated with CaCl2, 70% of the stored GFs are released within 10 minutes immediately after activation, and nearly 100% within the first hour. Therefore, it is recommended to be applied as soon as possible after activation. It is important to pay attention to this timing, especially in terms of methods that can be used with PRP.10,14 Uses of PRP in dermatology; In addition to chronic wounds, ulcers and burns, it has been successfully used in the field of cosmetic dermatology based on the principle of wound healing.15-18 Besides PRP can be used alone, it can be used after invasive/non-invasive cosmetic procedures (eg, chemical peeling, roller, laser, RF, etc.) can also be used in combination with these methods to increase and accelerate wound healing.12,19 Although there are not many combination studies in the field of cosmetic dermatology, there is a trend in line with the increasing popularity of PRP recently. The number of studies conducted in this way is increasing. For the treatment of melasma and postinflammatory hyperpigmentation (PIH), PRP application can be combined with other treatment options. TGF-b1 has melanogenesis inhibitory properties.20 Therefore, PRP very rich in TGF-b1 can be used alone or in combination with laser, chemical peeling, mesotherapy and rollers in melasma or PIH. It is inevitable that topical application after procedures such as laser, chemical peeling, and roller for the treatment of melasma will create a synergistic effect. In addition, it has been proven that erythema, edema, pain, and sensitivity that may occur as a result of these procedures decrease with the application of PRP and increase patient satisfaction.9,12,19,21,22 PRP application can also be added after hair transplantation. The rationale for adding PRP treatment; It is to achieve stronger and fuller hair growth with angiogenesis facilitating growth factors such as VEGF8 and PDGF4 in its content and to minimize the 15-30% hair loss lost by elimination and absorption after the procedure. The combination of 4-6 sessions of PRP application after hair transplantation has started to be applied as a standard.23-27 Laser treatments and PRP application can be used in combination. Topical application of PRP to the laser-applied areas after fractional CO2 laser reduces the risk of acute side effects such as erythema, tenderness, edema, acne, milia and scar formation, permanent erythema and post-inflammatory hyper-hypopigmentation, accelerates healing, and It has been shown that the results obtained as a result of its combination with PRP are better.9,21,28 In a study conducted for acne scars, 14 patients underwent PRP application in the form of unilateral mesotherapy after ablative CO2 laser peeling, and unilateral PRP application Erythema, edema, and tenderness were found less in the area where the procedure was performed. In addition, the level of improvement of acne scars in the control examination 4 months later was found to be higher on the side of PRP. it was found that combined PRP applications were much better in terms of reduction of erythema and edema, and showed much improvement in terms of total improvement compared to saline. The results of topical PRP application were found to be close to each other compared to intradermal application, and it was emphasized that topical PRP application should be preferred because the pain scoring is very different. It has been proven in case studies that it gives better results in terms of both outcome and faster recovery compared to other cases.9,21,28,31 In the study conducted for posttraumatic scars; Fractional ErYAG application was applied to one side of the scars and topical PRP application was applied to the other side after fractional ErYAG laser application. It was found that the side combined with PRP improved more according to the scar severity scale.32 In another study conducted for the treatment of traumatic scars, a group of patients were treated with a fat graft mixed with PRP and a 1540 nm non-ablative Er-Glass laser combination was applied to these methods. Better results were obtained after application with combinations than when applied alone.33 In a study of 22 patients for acne scars, topical PRP treatment was given to each patient after 3 fractional ErYAG applications, erythema lasted less than 3 days, and acne inflammation was not observed. The improvement in acne scars has been reported to be between 50-90%.34 PRP can also be combined with RF treatments. In a study conducted on 19 Asian female patients in which the combination of PRP with Bipolar RF was evaluated for the treatment of striae; Three sessions of bipolar RF were applied intradermally to the striae at 4-week intervals, and then PRP was administered intradermally to the striae areas. In the evaluation, it was concluded that the combination therapy significantly improved the striae. 35 In another study conducted on 18 patients for the treatment of striae, a method in which unipolar RF can be given together with ultrasound waves was applied to the striae areas, and then the ultrasound head was used. PRP was applied to striae areas; Statistically satisfactory results emerged as a result of applying this combination every 2 weeks for a total of 4 sessions. 36 Although evidence-based examples have not yet been found in the literature, the combination of PRP with chemical peeling and microneedling (roller) application would be appropriate. ; it can also be said that 2-4 sessions of PRP would be appropriate to increase the skin rejuvenation and revitalization effect before BoNTA and filler applications. As a result; Combining applications in the field of cosmetic dermatology with PRP has recently become popular and is becoming increasingly common. Since it is an autologous product, it does not pose an allergic reaction risk, faster recovery of acute side effects (erythema, edema, etc.) caused by the procedures performed and permanent side effects (PIH, It is obvious that the combination of PRP with cosmetic applications will increase day by day as it reduces the risk of scarring, etc., and lastly, increases the positive effects of the procedures performed synergistically thanks to the beneficial effects of the growth factors in its content.