April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Reprinted by permission of Aesthetic Plast Surg. 2015; 39(4):495-505.

Aesth Plast Surg (2015) 39:495–505 DOI 10.1007/s00266-015-0504-x

REVIEW

AESTHETIC

Platelet Preparations for Use in Facial Rejuvenation and Wound Healing: A Critical Review of Current Literature

Anthony P. Sclafani 1

• James Azzi 2

Received: 14 February 2015 / Accepted: 12 May 2015 / Published online: 5 June 2015 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2015

Abstract In facial plastic surgery, the potential for direct delivery of growth factors from platelet preparations has been of particular interest for use in facial rejuvenation, re- covery after facial surgery, and wound healing. A literature search was conducted through PubMed for the terms PRP, PRFM, platelet - rich plasma, platelet - rich fibrin matrix, platelet preparations, platelet therapy, growth factors, pla- telet facial, platelet facial rejuvenation, platelet wound healing, platelet plastic surgery. Articles pertaining to the use of platelet preparations in facial surgery and wound healing in plastic surgery after 2001 were included. Thirteen in vitro studies showed use of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) had a significant effect on cellular activity. Twenty-four out of 28 animal studies ex- hibited favorable results with use of a platelet preparation, including five of six studies that showed enhanced fat graft survival with addition of a platelet preparation. Twenty-three case series and clinical trials were identified, only two of which showed no differences. Twenty-one reported favor- able results with use of various platelet preparations. A total of 47 studies used PRP, four studies evaluated Leukocyte- rich PRP, and fourteen studies used PRFM. The vast majority of studies examined show a significant and measurable effect on cellular changes, wound healing, and facial esthetic out- comes with use of platelet preparations, both topical and

injectable. One must also consider possible publication bias against null results that may have had an influence on the data that were available for review. However, the preponderance of studies suggests that platelet preparations might represent an as-of-yet untapped adjunct in facial plastic surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full de- scription of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Platelet-rich plasma Platelet-rich fibrin matrix Platelets Growth factors Platelet gel Platelet- rich fibrin Platelet preparations, such as platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM), have been used in plastic surgeries to deliver growth factors directly to tissue. The most common growth factors (GFs) concentrated in these prepa- rations include platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF- b ), vascular endothe- lial growth factor (VEGF), epidermal growth factor (EGF), and insulin-like growth factor (IGF). These GFs are chemo- tactic for monocytes, fibroblasts, stem cells, endothelial cells, and osteoblasts and are mitogenic for fibroblasts, smooth muscle cells, osteoblasts, endothelial cells, and keratinocytes. They enhance production of collagen and fibronectin, increase vascular permeability, and promote angiogenesis [ 1 ]. These theoretical advantages in enhancing wound healing and aug- menting tissue are of particular interest to the facial plastic surgeon for cosmetic use, enhancement of recovery after surgery, and improved wound healing. Keywords Introduction

& Anthony P. Sclafani drs@nyface.com

1 Department of Otolaryngology, Weill Cornell Medical College, 1305 York Avenue, 5th Floor, New York, NY 10021, USA 2 Department of Otolaryngology-Head and Neck Surgery, New York Eye & Ear Infirmary of Mt. Sinai, 310 East 14th Street, 6th Floor, North Building, New York, NY 10003, USA

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