Fat Graft, Laser CO₂ and Platelet-Rich-Plasma Synergy in Scars Treatment

Fat Graft, Laser CO₂ and Platelet-Rich-Plasma Synergy in Scars Treatment

The Fractional laser of the Prins Hendrik Clinic works by targeting both the epidermis and dermis. Proper scar classification is important because differences in clinical scar characteristics determine the treatment protocol.1 Scar color, texture, and morphology, as well as previously applied treatments, will affect the laser parameters and number of treatments required for optimal improvement.2,3 See Table 1. These side effects include: Acne- It is common that you will develop tiny white bumps after your treatment. Subcision and excision may be used as well on the deeper scars. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery. All of these techniques have their limitations, risks and periods of cosmetic disability. Patients with olive skin, brown skin or black skin may be at increased risk for pigmentation changes no matter what type of resurfacing method is recommended.

Also acne scars of all severity can have laser acne scar removal treatments to improve the appearance of their skin. Topical anesthetics are used to numb small treatment areas. You will need to arrange a ride home after laser skin surgery due to the swelling and bruising associated with the procedure. Under the epidermis is a network of collagen and elastin, which are proteins that keep your skin youthful and tight. For deep abrasions, or if the entire face is going to be treated, you may need stronger anesthesia, pain killers, sedation, or general anesthesia. The goal of treatment is to raise the base of the scar to the normal skin level or to soften the edges of the scar to make the scar less noticeable. If hyperpigmentation is present, consider postponing subsequent laser treatments to avoid interference from a competing chromophore (or target), such as melanin.

These are effective in treating raised scars, while dermal fillers can fill in depressions caused by acne scars. If you develop a purple discoloration following the procedure, makeup can be applied but should be removed gently. Based on the results we obtained by combining fat graft with lasers and PRP in cervico-facial rejuvenation [8], it came up with the idea to use this association in scar treatment. Between 2008 and 2013, 64 patients were enrolled in the study, 21 with contractile scars and 43 with atrophic scars. Swelling of treated skin may occur immediately after laser irradiation, but generally subsides within 48 hours. All the patients gave an informed consent, their full medical history and were photographed before and after the treatment. The sunburn sensation is likely to continue after the treatment.

For deeper resurfacing, the upper levels of the reticulas dermis can also be removed. A microdermabrasion is beneficial to people with dull, dry, rough skin, acne prone or oily skin and mild acne scarring. He or she should explain the procedure in detail, along with its risks and benefits, the recovery period and the costs. P. They were injected in the mid and deep dermis. During the initial burst of activity within the first hour, about 95% of the presynthesized growth factors were released, and during the remaining 7 days of their viability, the platelets were synthesized together with the secret additional growth factors. To protect your skin after treatment, wear sunscreen of SPF 30 or higher, avoid direct sun exposure for at least 3 months, and wear a wide-brimmed hat when you’re in the sun.

Acne scars. The pre-operating process consisted of blood tests (biochemistry and coagulation), anti-bruising and antiviral medication. As stated, resurfacing with a carbon dioxide laser can carry many potential risks such as delayed posttreatment hypopigmentation and scarring, as well as prolonged healing after the procedure.[51] This ablative laser can be effective alone for scarring after acne, but the risks must be considered before a patient undergoes this procedure. The patients were hospitalized for 1 day, at departure they were recommended emollient creams and creams with SPF 50ⁱ for 1 month. The follow-up took place after 1 week, 1, 3, 6 months. Results were gathered through photographs (Canon camera in natural and artificial light) and the following aspects were assessed on a 4-point scale as excellent, good, fair, poor: scar appearance, skin condition, symptoms, edema, ecchymosis, recovery time (Table 1). Regarding the patients’ overall satisfaction rate, over 50% rated the treatment as excellent (55.81% in atrophic scars and 52.38% in contractile scars).
Fat Graft, Laser CO₂ and Platelet-Rich-Plasma Synergy in Scars Treatment

A dual-mode Er:YAG laser operated at a fluence of 22.5J/cm2 achieves comparable results with a single pass. The most bothersome symptom was post lipofilling edema, lasting in some cases, up to 1 month, more pronounced in the atrophic scars (30.23%) compared to contractile scars (9.5%). This difference may result from the location of lesions. Risks associated with laser resurfacing include: burns or other injuries from the heat of the laser energy, scarring, and obvious lightening or darkening of the treated skin. The photo below shows one of our patients after one treatment with Pearl Fusion. Once this stage is reached, your surgeon will provide instructions on how to gently wash and care for your healing skin. To achieve maximum improvement you will need at least four treatments 4 weeks apart.

Our results are matched with the results presented by Cervelli V. in 2012 [10], regarding the association of fat graft, PRP and laser in scar treatment. The differences were between the lasers; we used an ablative fractional laser, they used a non-ablative one, and we did all the procedure in one day, so the recovery time and side effects were more evident. Color changes in the skin can be improved, especially when dermabrasion is used with a bleaching agent and tretinoin (Retin-A), which can enhance the bleaching agent’s effects. This is true regarding the incision, vaporization and coagulation. In 2004, Sadick and Schecter[58] treated 8 patients with 6 monthly irradiations of 3 passes each and found a modest improvement. Even with surgical lasers, concomitant effects leave tissue alive and well, but also stimulate the tissue, and these are classified as low level laser therapy (LLLT) [11].

HLLT occurs at temperatures from above 40°C and 200°C and, depending on the temperature, can achieve carbonisation, vaporization, coagulation, denaturation and degradation of proteins. In our study, the major photosurgical effects were coagulation and protein degradation, which are sufficient to induce the wound healing process. LLLT on the other hand, works at temperatures under 40°C, or with no temperature rise at all, and induces photobioactivation without any damage. The newest approach in the treatment of acne and atrophic scarring includes the use of a nonablative radiofrequency device. It is well accepted that the energy of photons when absorbed directly in cells or tissue during the LLLT process may affect cellular metabolism and signaling pathways. Reported results include increased cell proliferation and migration (particularly by fibroblasts), increased tissue oxygenation, modulation in the levels of cytokines, growth factors and inflammatory mediators [12]. For cost containment and convenience, laser resurfacing is usually done on an outpatient basis.

One treatment does not preclude the use of others. Based on the recent data released by Robert E. Depending on the type of peel, possible side effects may include mild redness, drying and/or flaking of the skin, itching, swelling, burning, blistering, skin discoloration and possible crusting of the skin. The immediate effect was to shorten the healing time (peeling) post laser from 7 days to 4 days and we believe that further increased the graft survival. However, further studies both in vitro and in vivo are needed to see if by mixing these factors with adipose tissue (somewhere in his processing before being reinjected) the survival of regenerative cells increases. The present study, was administered separately, due to the assumptions that blood macrophages could destroy the transplanted fat cells – Sommer B. You need to prepare yourself for how your skin will look immediately after treatment and throughout the healing process.

Given the condition that the patients were enrolled in this study, scars, obtaining histological proofs was impossible. The authors additionally suggested that LASH could be used for hypertrophic scar revision. Histological examination showed a significant difference in the collagen structure, the number of adipocytes and the presence of young adipocytes between stimulated and un-stimulated fat graft (Fig. 5 ). Adipocytes seen without laser stimulation (a) and with laser stimulation (b). Immunohistochemical staining forDlk1(400x) using MAb (mouse antibody) to Dlk1 (human) at dilution 1:500, shows cytoplasmic staining of preadipocytes (black arrow) in the laser … Given the results we can conclude that the association of an ablative laser CO2 with PRP and autologous fat graft seems to be a promising and effective therapeutic approach for atrophic and contractile scars.

In general, we can affirm that the treated areas regained characteristics similar to normal skin, which are clinically objectivable, leading not only to aesthetic but also functional results. Further studies are needed to explore the potential use of this combined treatment in HIV+ patients on HAART therapy with atrophic lipodistrophy, patients with scleroderma, and patients with irradiated tissues.

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