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Efficacy of autologous platelet-rich plasma combined with hyaluronic acid on skin facial rejuvenation: A prospective study

      To the Editor: It has been reported that hyaluronic acid (HA) and autologous platelet-rich plasma (PRP) play an important role in the tissue regeneration process by stimulating cell signaling at the injection site. The aim of this open label prospective study was to assess the clinical benefit of combining PRP and HA (PRP-HA) effectors, which have synergic effects on skin firmness and elasticity, using objective assessment by a Cutometer MPA 580 (Courage-Khazaka Electronic GmbH, Cologne, Germany)
      • Ahn S.
      • Kim S.
      • Lee H.
      • Moon S.
      • Chang I.
      Correlation between a Cutometer and quantitative evaluation using Moire topography in age-related skin elasticity.
      of the software-evaluated skin mechanical parameter R:R5 (net elasticity) together with a validated subjective scale, the FACE-Q.
      • Pusic A.L.
      • Klassen A.F.
      • Scott A.M.
      • Cano S.J.
      Development and psychometric evaluation of the FACE-Q Satisfaction with Appearance scale: a new patient-reported outcome instrument for facial aesthetics patients.
      This study was approved by the French Health Authorities, and ethical approval was obtained from Comité de Protection des Personnes (CPP) Ile-de-France VI (ID RCB 2014-A00718-39). This trial was registered at ClinicalTrials.gov under the identifier NCT02832583. The BCT-HA kit (RegenLab SA, Le Mont sur Lausanne, Switzerland), which consists of tubes designed to prepare a mix of PRP and HA, was used. The hyaluronic acid (40 mg [2% wt/vol] of noncross-linked HA, 1550 KDa) was used at the same proportion as PRP (2 mL of PRP and 2 mL of HA).
      • Aguilar P.
      • Hersant B.
      • SidAhmed-Mezi M.
      • Bosc R.
      • Vidal L.
      • Meningaud J.P.
      Novel technique of vulvo-vaginal rejuvenation by lipofilling and injection of combined platelet-rich-plasma and hyaluronic acid: a case-report.
      Mesotherapy was performed using topical anesthesia (EMLA cream 5%, Astrazeneca AB S, Sodertalje, Sweden) at 0, 1, and 2 months by injecting 4 mL of the mixture per cheek. The procedure was performed in 2 steps. The first step consisted of deep intradermal injections of PRP-HA using a 1-mL syringe with a 32-guage needle every 5 mm per cheek. The second step consisted of spreading 1 mL of the mixture per cheek followed by intradermal punctures made by using a grid with punctures every 1 mm and a 1-mm SkinRoller (Aesthetic Group, Puiseux-le-Hauberger, France) (Fig 1). All outcomes were assessed before injection (baseline) and at 1, 3, and 6 months after the last injection session. No subjects dropped out before the 6-month assessment.
      Figure thumbnail gr1
      Fig 1Illustration of platelet-rich plasma–hyaluronic acid injection techniques.
      A total of 31 patients were recruited under the assumption of a 20% dropout rate, 20% size effect from treatment, bilateral 5% alpha risk, and 80% beta risk. The mean age of the 31 patients included in the study was 51.8 plus or minus 8.5 years. Comparison of FACE-Q scores showed significant improvement at 6 months compared with baseline (44.3 ± 1.9 at baseline versus 52 ± 3.17 at 6 months, P = .03). Similarly, biophysical measurements showed significant improvement for R5 (P = .036*) from baseline (Fig 2). No serious adverse event was reported.
      Figure thumbnail gr2
      Fig 2Skin elasticity parameters (R5:R) over time. The values represent the means, and the error bars correspond to standard deviations. P value determined by analysis of variance with a leverage test. TTT, Time to treatment.
      In a study investigating the effect of HA on facial rejuvenation, Reuther et al
      • Reuther T.
      • Bayrhammer J.
      • Kerscher M.
      Effects of a three-session skin rejuvenation treatment using stabilized hyaluronic acid-based gel of non-animal origin on skin elasticity: a pilot study.
      reported that micropuncture injections of HA increased the net elasticity parameter (R5), showing improvement in skin elasticity. Moreover, a recent study showed that 3 sessions of PRP injection at 1-month intervals resulted in significant improvement of skin elasticity and skin smoothness parameters.
      • Cameli N.
      • Mariano M.
      • Cordone I.
      • Abril E.
      • Masi S.
      • Foddai M.L.
      Autologous pure platelet-rich plasma dermal injections for facial skin rejuvenation: clinical, instrumental, and flow cytometry assessment.
      Of note, the platelet number of PRP may vary depending on the individual from which the blood is drawn. Thus, treatment with PRP might show variable efficacy depending on the source of the PRP.
      The main limitations of this study were the lack of a comparison group and the difficulty of identifying the exact role of each factor (HA, PRP, and microneedling).

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        • Kim S.
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        Correlation between a Cutometer and quantitative evaluation using Moire topography in age-related skin elasticity.
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        • Klassen A.F.
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        Development and psychometric evaluation of the FACE-Q Satisfaction with Appearance scale: a new patient-reported outcome instrument for facial aesthetics patients.
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        Novel technique of vulvo-vaginal rejuvenation by lipofilling and injection of combined platelet-rich-plasma and hyaluronic acid: a case-report.
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        Autologous pure platelet-rich plasma dermal injections for facial skin rejuvenation: clinical, instrumental, and flow cytometry assessment.
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