Skin rejuvenation using platelet-rich plasma products

The concepts of Skin health and beauty which are as ancient as mankind and civilization are considered as the main factors of human health and well-being. Therefore skin anti-aging strategies as well as skin rejuvenation methods that prevent, delay, repair and combat skin aging and eliminate its symptoms and maintain the structural and functional integrity of the skin, are of particular importance. Skin aging is a complex and unpreventable biological process that occurs as a result of both intrinsic and extrinsic factors such as physiological, behavioral, geographical, and environmental and lifestyle factors. This dynamic and multifactorial process results from the formation and accumulation of reactive oxygen species (ROS) and the induction of matrix metalloproteinases. Skin aging is characterized by a progressive deterioration of the skinchr(chr('39')39chr('39'))s functional properties, linked to alterations in dermal connective tissue due to the changes at the cell, gene and protein levels. Different physiological and pathological processes involved in skin aging, are accompanied by clinical manifestations such as cumulative structural and physiological changes in skin structure and appearance, pigmentation changes, reduced elasticity, and increased wrinkles in the skin. Considering the increasing trend of aging in the world, and the growing interest to maintain a youthful appearance, the demand for skin rejuvenation practices has greatly increased to improve the quality of life (QOL), self-esteem, and improved body image among aging population. The skin rejuvenation process uses a combination of different methods of bio-revitalization and techniques for repairing and strengthening different layers of the skin, along with changes in some other factors such as lifestyle, emotional and health status in order to relieve the aging signs. Platelet-rich plasma (PRP), derived from fresh whole blood, is a biological product which contains platelets concentrated above baseline level. Activated platelet cells can be considered as vehicles for growth factors and cytokine delivery, which play a crucial role in up-regulation of collagen production and controlling oxidative damage. Besides, growth factors reduce the signs of aging by modulating cell migration, proliferation, differentiation, angiogenesis and chemotaxis. They can also stimulate collagen synthesis, reverse the effects of collagenases, increase extracellular matrix accumulation, and promote endothelial and epithelial regeneration. This issue has caused PRP to be used in multiple clinical fields such as orthopedics, regenerative sport medicine, plastic surgery, dermatology and aesthetic medicine, gynecology, ophthalmology, and dentistry, with remarkable results. Skin rejuvenation, dermal augmentation, hair restoration, and acne scaring, are some of PRP dermatological indications. Topical application or direct injection of PRP compositions into the dermis can be considered as one of the simplest biological interventions in the field of reconstructive medicine and aesthetic treatments because of their capability to function as vehicles for growth factors and cytokine delivery. GFs and cytokines have the potential to address skin aging through stimulation of cell regeneration. Different GFs including PDGF, TGF, VEGF and IGF present in PRP stimulate human dermal fibroblasts. In fact Topical application of PRP or its direct injection into the skin, augment dermal elasticity by stimulating the removal of photodamaged extracellular matrix and induces the synthesis of new collagen and other matrix components by dermal fibroblasts via various molecular mechanisms. The ability of PRP to stimulate hyaluronic acid synthesis is another possible reason for skin rejuvenation. It should be noted that the topical application of Cosmeceutical formulations, containing biologically active ingredients, is preferable to invasive methods or systemic treatments. Because it is a safe, non-invasive, fast and simple procedure with the ability of topical delivery of active ingredient and direct impact on the desired location, fewer possible side effects and toxicities, and high user acceptability. Furthermore topically applied cosmeceutical preparations have advantages such as more solubility and spreadability, less drug degradation and enhanced bioavailability. Biocompatibility and biosafety, high clinical efficacy, fewer side effects, ease of use, non-invasiveness and greater acceptance and satisfaction of consumers, easier legal requirements, minimal manipulation, access to different methods of preparation, the possibility of adding different compounds to their formulation, reduced recovery time and downtime for patients, better aesthetic outcome, having antimicrobial activity and regeneration effect are some of PRP therapy benefits. However customizing PRP formulations for different clinical situations is an important challenge and should be carefully considered to achieve optimal efficacy, safety, tolerability, and stability. This article briefly discusses the concepts of skin health and beauty, skin aging and its clinical manifestations, classification of skin aging according to its causative factors, Skin rejuvenation strategies, mechanism actions of growth factors and platelet-rich plasma in skin rejuvenation, benefits of PRP therapies, Platelet preparation method, factors affecting the quality of PRP products, and formulation challenges.