PRILLER: A Winning Combination

 
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The ageing process affects every part of the body. The effects of this complex process tend to be particularly noticeable on the appearance of the face and has thus subsequently driven the desire for facial rejuvenation.

Facial ageing is known to occur in four main layers: skin, fat, muscle and bone. Over time, regeneration of cells in the epidermis (the outer layer of skin) slows down. However, the main age-dependent changes occur in the dermis (the inner layer of skin) which becomes thinner and less elastic with time, due to the reduction of collagen, hyaluronic acid and elastin. The associated loss in moisture further contributes to the formation of wrinkles. Muscle tone decreases gradually and the skin directly attached to it starts to sag. Finally, the bony support and foundation also undergo a reduction in mass, particularly the eye sockets.

Platelet-rich plasma (PRP) is an innovative new technique for facial and skin rejuvenation. It is a minimally invasive non-surgical treatment which involves concentrating the levels of platelets from a patient’s own blood sample and injecting it into specifically chosen areas. This has led to the term “vampire facelift” being often used to describe this technique. Platelets, alongside red and white blood cells, are one of the numerous constituents of blood and are held in a yellowish coloured liquid called plasma. Platelet Rich Plasma, as the name suggests, refers to plasma with highly elevated concentrations of platelets. This is achieved by collecting a small amount of the patient’s own blood and “spinning” (centrifuging) it to separate out the various blood components and isolating the platelet-rich plasma. The PRP is then re-injected into the skin using a very fine needle to promote skin rejuvenation. Scientific research has shown that platelets serve as a reservoir for several molecules, including growth factors, which promote wound healing. This has led to their use through PRP in aesthetic surgery after it was hypothesised that PRP induces the production of collagen, thus rejuvenating the skin. PRP is also widely used in other fields where repair and regeneration are required, including tendon surgery and treatment of hair loss.

PRP can be applied to most areas of the body and is performed as a day-case procedure. Following harvesting of the patient’s blood sample and preparation of the PRP, it is injected in the area of skin to be treated. The injections are well tolerated and most people will experience mild swelling and minor redness at the injection site. Bruising, which may also occur, can take several days to disappear. Results typically take several weeks to be apparent and two to three treatments are usually needed six weeks apart. PRP can be used alone or in conjunction with other treatments such as fillers.

Dermal fillers are one of the most widely used aesthetic products worldwide. They are used to target and fill out wrinkles and creases in the skin or to add volume and definition to areas of the body that needs it. Although very fashionable currently, this technique is thought to have been developed in the early part of the 20th century when paraffin and silicone were used as a skin filler for cosmetic applications but shortly abandoned following complications. Nowadays, over a hundred different types of dermal fillers exist which can provide both temporary and permanent results. Since the first generation of dermal fillers consisting of bovine collagen was approved by the U.S Food and Drug Administration (FDA) in 1981, several other filling agents have been developed for cosmetic injection. Hyaluronic acid (HA) rose to popularity in the early 2000’s as Hylaform, shortly followed by Restylane and to this day still remains one of the most common treatment options for wrinkles. HA is a naturally occurring compound present in the human body involved in skin hydration and healing.

Dermal fillers can be used to improve deep “smile lines” (nasolabial folds), “crow’s feet” lines in the eyes (lateral canthus), “frown lines” between the eyebrows or to add volume and definition to the lips or jaws, amongst others. They are usually administered as an “office” based procedure, lasting less than an hour. Following an injection of the filler, the affected area is sculpted to shape the filler. Patients may experience tenderness, redness, swelling or bruising immediately following the injection and this can last for a few days.

Although dermal fillers provide an excellent volumetric augmentation, their effects on the ageing process are limited. Combining dermal fillers and PRP allows the temporary creation of volume (from the filler) while ensuring the development of fibroblast cells and increasing the production of collagen to tackle the ageing process (from the PRP). At the Plastic Surgery Group (PSG) clinic, we have named this combination “PRILLER”. Mixing both PRP and dermal fillers together as a single injection is an innovative approach to aesthetic facial rejuvenation and provides longer lasting results.

Research has shown that this combination therapy results in an improved visible general appearance, skin firmness and texture as well as overall patient satisfaction. This is due to the acidic environment provided by the HA filler which has been proven to boost the concentration of growth factors while also enhancing the proliferation of fibroblast cells which produce collagen. Although a relatively new technique, the combination therapy of PRP and dermal fillers has shown promising potential by working synergistically to ultimately deliver better results. We at the PSG have noticed that PRILLER results in a more effective therapy than PRP or HA used alone, thus creating a winning combination for our patients.