Autologous platelet concentrates for facial rejuvenation

Abstract Autologous platelet concentrates (APCs) are promising therapeutic agents in facial rejuvenation since they are a great source of cytokines, growth factors and other biologically active substances. Obtained from the patient’s blood, they have the advantages of reducing immunological reactions, making the procedure safer, well tolerated, with minimal adverse effects and lower cost. Currently, they are used for facial rejuvenation both in combination with microneedling and in mesotherapy techniques, as well as to treat facial acne scars, melasma and wounds after laser ablative treatments. This review summarizes current knowledge on the use of APCs, ranging from basic concepts related to their composition and mechanisms of action to up-to-date information on their clinical efficacy. Methodology MEDLINE (PubMed) was searched from inception through 2021 for English language publications on APCs for facial rejuvenation. Results A total of 100 files were found. Based on the available literature, APCs for skin rejuvenation are safe and well tolerated. The most studied product is the first-generation material, platelet-rich plasma (PRP). Conclusions The results are in general favorable, but the quality of the studies is low. The second and third generation products, platelet-rich fibrin (PRF) and injectable platelet-rich fibrin (i-PRF), respectively, are easier to be obtained and, at least in vitro , seem to induce greater collagen production than PRP, especially under lower relative centrifugation forces, but to date only a few clinical trials evaluating these products exist. More high-quality trials with appropriate follow-up are necessary to provide adequate evidence that may help to improve the treatment regimens with APCs. Many aspects should be considered when designing clinical trials to evaluate APCs, such as the patients’ characteristics that best predict a favorable response, the optimal number of sessions and the interval between them, the characteristics of the studies and the development of better instruments to evaluate skin aging.

摘要 自体血小板浓缩物（Autologous Platelet Concentrates, APCs）是面部年轻化领域极具潜力的治疗制剂，因其富含细胞因子、生长因子及其他生物活性物质。该类制剂源自患者自身血液，具备降低免疫反应、提升治疗安全性、耐受性佳、不良反应轻微且成本较低等优势。目前，其既可联合微针治疗与中胚层疗法用于面部年轻化，亦可用于治疗面部痤疮瘢痕、黄褐斑以及激光剥脱术后创面。本综述总结了当前关于APCs的研究认知，涵盖其组成与作用机制等基础概念，以及其临床疗效的最新研究进展。
研究方法 本研究检索了MEDLINE（PubMed）数据库自建库至2021年期间发表的、关于APCs用于面部年轻化的英文文献。
结果 共检索到100篇相关文献。基于现有文献可知，用于皮肤年轻化的APCs安全性良好且耐受性佳。其中研究最为广泛的产品为第一代制剂富血小板血浆（Platelet-Rich Plasma, PRP）。
结论 整体而言，现有研究结果呈积极趋势，但相关研究质量普遍偏低。第二代、第三代制剂分别为富血小板纤维蛋白（Platelet-Rich Fibrin, PRF）与注射用富血小板纤维蛋白（injectable Platelet-Rich Fibrin, i-PRF），其制备流程更为简便，且至少在体外实验中，相较于PRP，即便在较低相对离心力条件下，似乎也可诱导更多胶原蛋白生成。然而截至目前，针对此类制剂开展的临床试验仍较为有限。未来需开展更多设计严谨且具备适当随访周期的高质量临床试验，以提供充分证据，助力优化APCs的治疗方案。在设计评估APCs的临床试验时，需考量诸多因素，例如可最精准预测良好治疗应答的患者特征、最佳治疗次数与间隔周期、研究设计规范，以及研发更优质的皮肤衰老评估工具。