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Injection Therapy to Enhance Skin's Appearance

Introduction to Injection Therapies

Botulinum toxin is the oldest injection therapy to minimize the appearance of fine lines and wrinkles on one’s face.[1] Other injectable treatments such as dermal fillers, microlipoinjection, and more alternatively, platelet-rich plasma injections can also be used to reduce the look of aging and maintain youthful-looking skin.[1] 

How to Assess and use Injection Therapy for the Skin and Modifications

Botulinum Toxin to Enhance the Skin’s Appearance

Botulinum toxin is used as a common non-surgical procedure to maintain a youthful appearance. Botulinum toxin is a protein derived from the anaerobic bacterium Clostridium botulinum.[1] Neural transmission is disrupted by botulinum toxin by inhibiting the release of acetylcholine at the neuromuscular junction, which causes muscle paralysis lasting around three to six months.[1] The use of Botulinum toxin-A in the form of Botox® has been FDA approved for cosmetic purposes including temporarily diminishing the look of fine lines and wrinkles.[1] Two other FDA approved Botulinum toxin injectors are Dysport® and Xeomin®.[2]

Dermal Fillers to Enhance the Skin’s Appearance

Dermal fillers are another common non-surgical procedure that have a different mechanism of action than Botulinum toxin.[3] Dermal fillers physically fill into lines and folds to correct soft tissue loss due to the aging process. Volume replacement and enhancement of the lips, nose, chin, and hands are also performed with the use of dermal fillers.[4,5] The different types of dermal fillers include:[6,7]

  • Hyaluronic Acid
  • Calcium Hydroxylapatite
  • Polyalkylimide
  • Polylactic Acid
  • Polymethyl-Methacrylate Microspheres (PMMA)
  • Collagen

Microlipoinjection/Fat Grafting to Enhance the Skin’s Appearance

Microlipoinjection is a surgical procedure to transfer one’s fat from the thigh or buttock to the face in a process known as facial rejuvenation.[8] Fat grafting is indicated in patients who have facial hollowing and atrophy, as well as facial sagging due to aging.[8] The collected adipose tissue is then injected into the patient’s face.[8] One-third of the injected adipose is not reabsorbed into the body, and can remain in the injected location for years.[8]

Platelet-Rich Plasma to Enhance the Skin’s Appearance 

Platelet-rich plasma (PRP) is a solution that contains variable concentrations of platelets from human blood.[9] The patient's own blood is centrifuged and injected into the skin or applied topically along with ablative lasers and microneedling to stimulate collagen production and enhance the skin's appearance.[9,10] Platelet-poor plasma (PPP) is a product of centrifugation, and may be discarded in some instances.[11] Along with high concentration of platelets, PRP contains growth factors, transforming growth factor beta, epithelial growth factor, and vascular endothelial growth factor.[12] There are four subsets of PRP which include: pure PRP, leukocyte and PRP (L-PRP), platelet-rich fibrin matrix (PRFM), and leukocyte-and-platelet-rich fibrin matrix.[13]

Table 1: Type of Platelet-Rich Plasma, Preparation and Final Constituents[11]

 

Type of Platelet-Rich Plasma

 

 

Preparation Methods

 

Final Constituents

Pure Platelet-Rich Plasma

Anticoagulated blood collected from the patient, centrifuged, yielding a portion of PPP and buffy coat. A second, high-force centrifuge used, and PPP is discarded.

Concentrated platelets and fibrin-rich plasma. Low concentration of leukocytes.

Leukocyte-and Platelet-Rich Plasma

Anticoagulated blood collected from the patient, centrifuged, yielding PPP and buffy coat that are collected.

Concentrated platelets, leukocytes, red blood cells, and fibrin-rich plasma.

Platelet-Rich Fibrin Matrix

Anticoagulated blood collected from the patient, centrifuged, yielding PPP and buffy coat which are collected with a separator gel to cause clotting in the presence of Calcium chloride. A second, high-force centrifuge used, and a subsequent clot is collected.

Fibrin polymerized clot, rich in platelets and moderately rich in leukocytes.

Leukocyte-and Platelet-Rich Fibrin Matrix

Venous blood collected and centrifuged without an anticoagulating agent. The subsequent clot is collected.

Platelet-rich, leukocyte-rich fibrin polymerized clot

Clinical Research and/or Case Studies for Injection Therapy for Skin

Botox and dermal fillers are well studied to be effective in temporarily reducing the appearance of lines and wrinkles.[1,3,4] Platelet-Rich plasma is a newer aesthetic procedure, with less research. Of the studies, one, which lacked a control group, noted cosmetic improvements in the neck and face after monthly PRP injections.[14] Crow’s feet[15] and infraorbital wrinkles[16] were also shown to diminish after PRP injections.

Clinical Considerations

Botulinum toxin[1] and dermal fillers[3] have been the most common non-surgical injectable techniques to diminish the appearance of fine lines and wrinkles, as compared to the more invasive fat grafting procedures. New literature is emerging as more research is being done on platelet-rich-plasma. A few studies have shown promising effects of PRP, but more research is needed to evaluate the safety and efficacy of injection treatments and its role in cosmetic dermatology.[11,15]

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol.2010;55(1):8-14; PMID: 20418969 https://www.ncbi.nlm.nih.gov/pubmed/20418969.
  2. Vaughn A, Veerula V. Botulinum Toxin injections : Botox vs Dysport vs Xeomin. LearnSkin.2022. https://www.learnskin.com/articles/botulinum-toxin-injections-compared
  3. Ballin AC, Brandt FS, Cazzaniga A. Dermal fillers: an update. Am J Clin Dermatol.2015;16(4):271-283; PMID: 26081021 https://www.ncbi.nlm.nih.gov/pubmed/26081021.
  4. Rzany B, Hilton S, Prager W, et al. Expert guideline on the use of porcine collagen in aesthetic medicine. J Dtsch Dermatol Ges.2010;8(3):210-217; PMID: 20030742 https://www.ncbi.nlm.nih.gov/pubmed/20030742.
  5. Goldberg DJ. Legal ramifications of off-label filler use. Dermatol Ther.2006;19(3):189-193; PMID: 16784518 https://www.ncbi.nlm.nih.gov/pubmed/16784518.
  6. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging.2008;3(1):153-159; PMID: 18488885 https://www.ncbi.nlm.nih.gov/pubmed/18488885.
  7. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol.2013;6:295-316; PMID: 24363560 https://www.ncbi.nlm.nih.gov/pubmed/24363560.
  8. Marten TJ, Elyassnia D. Fat grafting in facial rejuvenation. Clin Plast Surg.2015;42(2):219-252; PMID: 25827566 https://www.ncbi.nlm.nih.gov/pubmed/25827566.
  9. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent.2001;10(4):225-228; PMID: 11813662 https://www.ncbi.nlm.nih.gov/pubmed/11813662.
  10. Shin MK, Lee JH, Lee SJ, et al. Platelet-rich plasma combined with fractional laser therapy for skin rejuvenation. Dermatol Surg.2012;38(4):623-630; PMID: 22288389 https://www.ncbi.nlm.nih.gov/pubmed/22288389.
  11. Leo MS, Kumar AS, Kirit R, et al. Systematic review of the use of platelet-rich plasma in aesthetic dermatology. J Cosmet Dermatol.2015;14(4):315-323; PMID: 26205133 https://www.ncbi.nlm.nih.gov/pubmed/26205133.
  12. Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents.2012;26(2 Suppl 1):3S-22S; PMID: 23648195 https://www.ncbi.nlm.nih.gov/pubmed/23648195.
  13. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol.2009;27(3):158-167; PMID: 19187989 https://www.ncbi.nlm.nih.gov/pubmed/19187989.
  14. Redaelli A, Romano D, Marciano A. Face and neck revitalization with platelet-rich plasma (PRP): clinical outcome in a series of 23 consecutively treated patients. J Drugs Dermatol.2010;9(5):466-472; PMID: 20480789 https://www.ncbi.nlm.nih.gov/pubmed/20480789.
  15. Mehryan P, Zartab H, Rajabi A, et al. Assessment of efficacy of platelet-rich plasma (PRP) on infraorbital dark circles and crow's feet wrinkles. J Cosmet Dermatol.2014;13(1):72-78; PMID: 24641609 https://www.ncbi.nlm.nih.gov/pubmed/24641609.
  16. Kang BK, Shin MK, Lee JH, et al. Effects of platelet-rich plasma on wrinkles and skin tone in Asian lower eyelid skin: preliminary results from a prospective, randomised, split-face trial. Eur J Dermatol.2014;24(1):100-101; PMID: 24566300 https://www.ncbi.nlm.nih.gov/pubmed/24566300.
 
 
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