About: Skin care begins with sun avoidance, good nutrition and effective topical products. However, these steps all have their limitations when it comes to combating aging and restoring younger, beautiful looking skin.
Skin resurfacing refers the removal of dead skin cells and stimulation of new skin cells. Skin resurfacing may include TCA peels, PRP (platelet rich plasma), microneedling, and CO2 laser resurfacing.
TCA (trichloroacetic acid) is a safe, non-toxic chemical that has been used for decades to perform facial skin peels as well as peels for the neck and backs of the hands. TCA peels are offered in different strengths that most appropriately fit one’s skin type, desires, and expectations. A TCA peel is performed easily in the office while one is awake. There is very little discomfort. A facial peel takes less than twenty minutes, and downtime is limited to some crustiness or scabbing of the face for several days after treatment.
PRP (Platelet Rich Plasma)
PRP therapy has become a hot topic in regenerative medicine. Platelet-rich plasma is a concentrate of thrombocytes (platelets) derived from blood. Platelets are reparative cells that contain growth factors and cytokines to promote healing of soft tissue. The main indications for PRP therapy in plastic surgery include penis enhancement, vaginal and clitoral enhancement, hair restoration, and skin rejuvenation. PRP works by introducing to the tissue a concentrated amount of growth factors and regenerative proteins, which accelerates healing inside the tissues. Because aged skin is essentially damaged skin, PRP facilitates the remodeling of collagen to improve tone, texture and skin color.
PRP is both injected and introduced via microneedling with depths of 0.5 mm to 2.0 mm depending on the region treated.
PRP Start to Finish
PRP is performed as an outpatient procedure. When it is injected or microneedled into the face, it has been referred to as a vampire facial or facelift, a title that has been trademarked by another physician who allows other doctors to license the use of the very catchy name for a fee.
Regardless of the name assigned to PRP therapy, the procedure generally involves the following steps. First, blood is drawn – typically from an arm vein – and then processed for approximately twelve minutes to concentrate the platelet-rich plasma. Topical anesthesia or facial nerve blocks can be used to reduce discomfort for the next step of the procedure, which is to transfer the PRP into 1 cc syringes for injection or microneedling.
Prior to this final step, the face is cleaned with alcohol. Multiple areas of the face or hand are injected with a small gauge needle, including the cheeks, under the eyes, temples, and any other area of concern. PRP is then applied to the skin and microneedling is performed at a depth of 0.5 to 2.0 mm to the face or hands.
The entire process takes approximately 45 minutes from start to finish. There is often punctate bleeding in certain regions treated. Mild redness may persist for up to a day.
Beyond PRP: Micronized Fat or Nano-Fat
Perhaps more powerful for skin regeneration than PRP is micronized fat, or nano-fat. Nano-fat refers to the filtration of fat to reduce its viscosity and allow the stromal components and stem cells to be injected directly into the dermis. Nano-fat grafting is an exciting, growing field of plastic surgery. While PRP contains growth factors, cytokines, and multiple regenerative proteins, nano-fat contains stem cells, the body’s true building cells.
Stem cells are undifferentiated cells that have the unique capacity to give rise to indefinitely more cells of the same type, or of different types of specialized cells. Because fat contains a plethora of stem cells, the use of one’s fat is a wonderful way to obtain stem cells for skin rejuvenation. Until recently, fat was too thick to inject into the skin. With the use of filtration devices, fat can be processed to allow it to pass through very fine needles directly into the dermis or sub-dermally to improve skin tone, texture, color, and elasticity.
PRP can be combined with fat injection. Early studies suggest that the combination of PRP and fat improves fat survival and may further enhance the effects of the stem cells.
Nano-fat Start to Finish
Nano-fat grafting begins with the harvesting of one’s fat, usually from the abdomen or love handles while you are awake. The fat is then processed through filters and transferred into 1 cc syringes. Depending on the area treated, topical anesthesia or nerve blocks may be used to reduce the discomfort of the injection. Fat is injected directly into the skin using a very fine needle.
The most common uses and areas for nano-fat transfer include underneath the eyes or in the lower eyelids, cheeks, lips, hands, and scars. PRP may be added into the fat or injected following the fat transfer. Recovery is quick. There may be bruising and mild swelling associated with the harvest of fat or its injection.
CO2 Resurfacing (Carbon Dioxide Laser)
Perhaps the most powerful skin resurfacing device on the market today is the traditional CO2 laser. The CO2 laser is the highest power continuous wave laser available for skin resurfacing. The CO2 laser should not be confused with fractionated CO2, or Fraxel (TM). Fractionated CO2 and Fraxel (TM) are effective, but weaker devices that yield inferior results to traditional CO2 resurfacing.
The CO2 laser removes the outer layer of skin with substantial precision, penetrating deeper than fractionated CO2 or Fraxel (TM). The result is a more dramatic effect, treating fine lines and deeper lines, as well as skin color, tone, texture, color, and elasticity.
The CO2 laser, because it is more powerful, must be used only in skilled hands. The downtime ranges from days to a week, and sun avoidance must be a priority for up to 30 days to avoid complications after the procedure.
While facelifts and fat transfer address skin laxity and volume changes with aging, they do not adequately correct some of the deepest wrinkles or dyschromia (color changes). CO2 is often a wonderful adjunct to facelift surgery, particularly in tightening up the lower eyelid. CO2 is also frequently used for scar revision, including both surgical scars and acne scars.