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    Therapy with platelet derived concentrate

    What is a treatment with plateled gel?

    The renewal of the body’s own tissue is the Holy Grail of medicine. Almost daily, science is expanding our understanding of how cells regenerate. Already in 1974 it was described that components of the blood, the so-called platelets, stimulate the renewal of cells [1]. Platelets, also known as thrombocytes, are nucleate cell elements that are formed from precursor cells in the bone marrow. A healthy person has about 150,000 to 400,000 platelets per microliter of blood. The name platelet or in English “platelet” is derived from the flat, disc-like shape of platelets. They are barely two micrometres in diameter and have small vesicles called granules in which messenger substances are stored.

    When the messenger substances are released, cells of the connective tissue and the scaffolding components around the cells proliferate. Platelet messengers promote the formation of collagen [2]. The development of new cells from stem cells is also stimulated. The skin colour, for example with dark eye rings, becomes more even. This anti-aging treatment with platelet gel improves the skin’s texture and elasticity and reduces the depth of wrinkles on the face and décolleté. In this context, this gentle lifting method is also popularly referred to as vampire lifting or vampire lift.

    In addition, the treatment with active substances derived from autologous blood is also used in certain cases against hair loss and is a popular alternative to a costly hair transplant. The hair loss therapy with autologous blood leads to an effective increase of hair follicles in the bald areas and thus promotes the formation of new hair with the result of a fuller hair. The thickness of the hair as well as the density of the hair in age-related and circular hair loss increases. However, the result is not expected in diffuse hair loss.

    In hair root treatment with the platelet gel, this is injected into the scalp to promote the formation of new hair roots in the event of hair loss and thus stimulate hair growth.

    The treatment makes use of the regenerative properties of platelets. These are administered in concentrated form. The skin rejuvenating effect of platelets was described in 2009 and is now well researched [3].

    Advantages of therapy with platelet gel

    Treatment with the body’s own plasma is distinguished by the following advantages when evaluated according to generally accepted standards:

    • Evidence-based efficacy: There are more and more high-quality and conclusive studies on the therapy every month that prove the benefits beyond doubt.
    • High safety: The risks of an allergic reaction, intolerance or the transmission of a disease are excluded with this therapy.
    • High pharmaceutical quality: Hygienic specialist blood sampling and the use of closed systems guarantee pure, uniform and standard-compliant production.
    • Cost-effectiveness and economy: Laboratory-produced messenger substances in comparable concentrations cost several thousand euros.
    • Availability: On average, an adult produces one hundred billion platelets each day to maintain a normal platelet count. If necessary, the body can increase the formation of new platelets tenfold [4]. This means that less than 0.01 percent of the platelets formed each day are used in treatment with the platelet gel.

    Who is suitable for autohaemotherapy?

    The benefits of therapy with the platelet gel have been proven in hundreds of studies, especially for the treatment of hereditary hair loss, the treatment of scars, stretch marks and skin rejuvenation. The treatment can be used alone or in conjunction with other procedures. There are no age restrictions for the application of the therapy, so that some patients are interested in or decide in favour of it even at an early stage when hair loss begins or when the first signs of aging appear on the skin. Patients over the age of 45 and with diabetes often require more treatments because the concentration of some growth factors is lower with age [5].

    We generally advise against aesthetic treatments in the case of severe underlying diseases. This applies to rare hereditary diseases of the blood platelets, as well as anemia, flu or fever. The intake of blood-thinning medications (for example Aspirin®, Thomapyrin®, Ibuprofen, Diclofenac) and cortisone preparations should be avoided two weeks before a treatment and two days after a treatment, as these medications impair the concentration of growth factors.

    Procedure of treatment with platelet gel

    Before each treatment, the specialist checks which measure, according to the state of science, will best achieve your goals. A detailed examination and a good consultation are important for the success of any treatment. You will then have about 20 millilitres of blood taken, just like a general health check. To prevent the body’s own blood from clumping together immediately after collection, the calcium is bound. This is done by adding anticoagulants such as citrate. The unclotted blood is then spun in a laboratory centrifuge. This causes the blood components to separate according to their density. The platelets accumulate in a specific location in the test tube.

    A gentle method should be used for processing and care should be taken when handling the platelets. Special preparation systems are available for the production. From our own many years of experience, closed systems have proven their worth. The blood cannot escape from the test tube, nor can anything enter the test tube from the outside. This process is more hygienic, standardized and reproducible. Several commercially produced systems are available for this purpose, for example Regenkit®, ACP Arthrex®. The systems including the centrifuge should be approved in the EU or have a CE marking.

    In certain systems, a gel filter is also used to separate the platelets. As a rule, platelet concentrations reach 2 to 9 times the blood value. Concentrations greater than one million platelets per microliter are generally considered effective [6]. To ensure that platelets are adequately nourished, excessive concentrations should be avoided [7].

    Contact with certain substances stimulates the platelets to release their messenger substances. Therefore, calcium or thrombin is occasionally added to concentrated platelets. When thrombin is added, it should be noted that allergic reactions may occur. Within a few minutes, the additives trigger the coagulation or clumping of the platelets. Since the collagen in the injected tissue also activates the thrombocytes and studies have shown the effectiveness of the treatment form without additives, we do not use them [8]. Without additives, the platelets gradually release the messenger substances into the tissue.

    Particularly fine cannulas are used for the careful injection of the platelets. Anaesthetic cream, the so-called “vibration anaesthesia” and supporting measures such as distracting background music or aromatherapy ensure a pleasant, almost pain-free treatment. The volume of the injection differs depending on the location and treatment. Generally, about 0.3 milliliters per square centimeter of skin surface are injected.

    Treatment of acne scars with platelet gel

    There are many misconceptions about the causes, treatment and consequences of acne. The rumor of a harmless disease has long been disproved by science. Acne and its sequelae are shown to be associated with stress, social withdrawal, stigma, anxiety, depression, sexual dysfunction, and suicidal ideation [9].

    The application of platelet gel in combination with a microneedling treatment results in a finer skin texture, a more even complexion and less visible scars. Studies show a high level of patient satisfaction [10]. A slight swelling or redness of the skin will improve within a few hours. The visible results are permanent and visible after only 3 months. We recommend three to six sessions at intervals of two to four weeks.

    Treatment of dark circles with platelet derived concentrate

    Several features can contribute to the formation of dark circles. The causes are hereditary and are aggravated by stress, lack of sleep, a lot of sun exposure or cigarette smoking. An effective treatment of dark circles is specifically based on the individual findings. According to the examination results listed below, we will give you different recommendations regarding the appropriate anti-aging methods:

    • Deposition of the skin pigment melanin

    Mild dark circles and tear troughs caused by the deposition of skin pigment can be effectively and safely treated with an injection of platelet gel [11]. The excessive formation of skin pigments is suppressed by the growth factors of the treatment with platelet gel (TGF and EGF) [12].

    • Shining through hair vessels

    Volume deficit under the eyes is permanently corrected by injecting the patient’s own fat or by correcting the fat pads as part of a lower eyelid lift [13]. Autologous fat injection provides harmonious contours and improves skin quality [14]. An autologous fat treatment is therefore often combined with the removal of excess eyelid skin or with a facelift. Temporary correction with filler is also possible and offers the advantage of very little downtime.

    • Shadow formation due to slackening of the connective tissue and fatty tissue shrinkage

    Volume deficit under the eyes is permanently corrected by injecting the patient’s own fat or by correcting the fat pads as part of a lower eyelid lift [15]. Autologous fat injection provides harmonious contours and improves skin quality [16]. An autologous fat treatment is therefore often combined with the removal of excess eyelid skin or with a facelift. Temporary correction with filler is also possible and offers the advantage of very little downtime.

    • Shadow formation due to skin wrinkles

    For thin, dry and inelastic skin, we recommend treatment with platelet derived concentrate in combination with micro needling. This results in an increase in collagen content, elasticity and skin thickness, which has a positive effect on small wrinkles in the skin. Excess skin, however, requires targeted correction through a lower eyelid lift. You can find out more on our lower eyelid liftpage.

    Treatment of crow’s feet with platelet derived concentrate

    Crow’s feet are a sign of decreased skin elasticity. In clinical studies, crow’s feet can be shown to smooth out significantly after three to six treatments with platelet derived concentrate [17]. Both the number and the depth of the wrinkles decrease. The results last for at least six months. By combining platelet gel with other procedures, the effect can be intensified. We recommend injecting platelet gel along with microneedling treatment as it gives better results than after platelet derived concentrate combined with peeling treatments [18].

    Therapy with platelet gel against wrinkles

    The body’s own growth factors of the treatment with platelet gel activate cells of the connective tissue and increase the collagen content of the skin. The skin texture is rejuvenated and the skin tone becomes more even. Incipient signs of aging of the facial skin can be improved by injecting the platelet derived concentrate [19]. Scientific research shows that the alignment of the collagen fibres after the combination treatment corresponds to the pattern of younger skin. Fine layer studies show that the damaged elastic fibers of the skin are degraded [20].

    Treatment of sun damaged skin with platelet gel

    Light-skinned people are particularly sensitive to sunlight. UV radiation often leads to the first wrinkles before the age of 30. Deep wrinkles between the ages of 40-50 can make people look older than they are. Ultraviolet radiation activates certain enzymes, also called metalloproteinases, which accelerate the breakdown of collagen [21]. The platelet-derived growth factors PDGF, TGF, VEGF, IGF and EGF improve skin texture. This usually requires three to six treatments.

    Platelet derived concentrate treatment for a wrinkle-free décolleté

    Often especially the décolleté is very spoiled by the sun. Exposure to the sun can cause dark skin spots and vascular markings on the décolleté. The collagen and elastin content of the skin decreases. Fine lines can make the skin appear pre-aged. The application of platelet derived concentrate in combination with microneedling is particularly suitable for minimizing skin spots. The efficacy and safety of this treatment combination is well established scientifically [22]. Both treatments have been shown to increase collagen and elastin levels in the skin [23]. We therefore recommend the combination of both treatments to reduce wrinkles in the décolleté. Visible and measurable improvements can be achieved by three to six treatments at intervals of about four weeks.

    Platelet gel treatments against pregnancy stripes

    Stretch marks or stretch marks are unsightly tears in the subcutaneous tissue that can occur in women and men of all ages. When the stretch marks appear for the first time, usually during puberty, they appear as red stripes (in Latin: striae rubrae). Stretch marks or stretch marks are unsightly tears in the subcutaneous tissue that can occur in women and men of all ages. When the stretch marks appear for the first time, usually during puberty, they appear as red stripes (in Latin: striae rubrae). After a few months the striae fade and an unsightly white tear in the skin remains (in Latin: striae albae). Most often, women are affected during puberty or pregnancy. Stretch marks occur preferentially on the thighs, hips, buttocks and chest. There is a lot of evidence for the effectiveness of the therapy for the treatment of stretch marks. Thus, it can be shown that skin thickness and the formation of collagen and elastin increase [24]. The combination with microneedling is significantly more effective than microneedling alone for the treatment of stretch marks [25]. We therefore recommend a combined treatment of stretch marks as early as possible. For optimal success, it should be repeated at least three times.

    How does the therapy with platelet gel work?

    The effect of platelet derived concentrate therapy is mediated by the body’s own platelets. Platelets contain an abundance of growth factors that they release in the target tissue. The effects of growth factors are highly complex and can vary depending on concentration and combination [26]. It is known that the effect of platelet gel treatment cannot be attributed to a single growth factor or messenger substance. The effect is rather based on a mutual amplification of the effect of many factors. A precise dose-response relationship between individual messengers and the activation of stem cells and the cell of the connective tissue is therefore also difficult to prove [27]. The growth factors are named after the first letters of the English terms. The main growth factors of platelet derived concentrate treatment are:

    VEGF (vascular endothelial growth factor):

    • Promotes the migration and proliferation of cells lining the inside of blood vessels,
    • Increases the permeability of blood vessels,
    • Promotes the growth of blood vessels and of cells on internal and external surfaces of the body,
    • Increases the formation of collagen [28].

    PDGF (platelet-derived growth factor):

    • Stimulates the breakdown of old collagen,
    • Activates progenitor cells in the supporting tissue,
    • Stimulates the proliferation of defense cells in blood and supporting tissues [29].

    FGF (fibroblast growth factor):

    • Stimulates the formation of new vessels,
    • Plays a role in tissue remodeling,
    • Promotes the migration of cells of the connective tissue of the skin [30].

    EGF (epithelial cell growth factor):

    • Increases the migration of cells of the epidermis,
    • Stimulates the migration of cells of the connective tissue of the skin,
    • Supports granulation tissue formation [31].

    TGF-β (transforming growth factor beta):

    • Promotes the formation of new vessels,
    • Activates the proliferation of cells of the connective tissue of the skin and cells of the epidermis,
    • Stimulates the formation of collagen, hyaluronic acid, fibronectin and proteoglycans [32].

    IGF (insulin-like growth factor):

    • Stimulates the proliferation of cells of the connective tissue of the skin [33],
    • Promotes hair growth.
    • Stimulation the proliferation of epidermal cells [34].

    Does a blood test have to be done before a platelet gel treatment?

    It is undisputed that the effect of the treatment comes from the messenger substances of the platelets. However, it is not possible to set a minimum or maximum limit on the number of platelets required for optimal effect. A blood test with determination of the platelet count is therefore not necessary before an platelet gel treatment. It is generally known that the number of platelets is influenced by various factors. The number of platelets can be significantly altered in pathological changes such as inflammation, bone marrow diseases, autoimmune diseases, genetic diseases or a vitamin deficiency. Slight deviations can also occur naturally or be caused by lifestyle habits. After the age of fifty, platelet count steadily decreases by four to five percent with each decade [35]. In general, women have about three percent more platelets than men [36]. Cigarette smokers have about 17 percent fewer platelets than nonsmokers [37]. With the same number of platelets, it can be shown that obesity has an unfavorable effect on the size of platelets [38]. An increase in blood glucose also adversely affects platelet size [39].

    Procedure for therapy with platelet derived concentrate

    Before each treatment, the specialist examines which measure, according to the state of science, will best achieve your goals. A detailed examination and a good consultation are important for the success of any treatment. Then, as with a general health check, a small amount of blood, about 20 millilitres, will be taken from you. To prevent the substance from clumping together immediately after collection, the calcium is bound in the blood. This is done by adding anticoagulants such as citrate. The unclotted blood is then spun in a laboratory centrifuge. This causes the blood components to separate according to their density. The platelets accumulate in a specific location in the test tube.

    A gentle method should be used for processing and care should be taken when handling the platelets. Special preparation systems are available for the production. From our own many years of experience, closed systems have proven their worth. The blood cannot escape from the test tube, nor can anything enter the test tube from the outside. This process is more hygienic, standardized and reproducible. Several commercially produced systems are available for this purpose, such as Regenkit® or ACP Arthrex®. The systems used by the physician, including the centrifuge, should always be approved in the EU or have a CE marking.

    In certain systems, a gel filter is also used to separate the platelets. As a rule, the concentration of platelets reaches 2 to 9 times above the blood value. Furthermore, the plasma is characterized by a low concentration of special leukocytes (white blood cells). Concentrations greater than one million platelets per microliter are generally considered effective [40]. To ensure that platelets are adequately nourished, excessive concentrations should be avoided [41].

    Contact with certain substances stimulates the platelets to release their messenger substances. Therefore, calcium or thrombin is occasionally added to the concentrated platelets by some practitioners. However, when thrombin is added, it should be noted that allergic reactions may occur. Within a few minutes, the additives trigger the coagulation or clumping of the platelets. Since the collagen in the injected tissue also activates the platelets and studies have shown the effectiveness of the treatment method without additives, we do not use additives [42]. Without additives, the platelets gradually release the messenger substances into the tissue. For the careful superficial injection of platelets, particularly fine cannulas are used. Anaesthetic cream, the so-called “vibration anaesthesia” and supporting measures such as distracting background music or aromatherapy ensure a pleasant, almost pain-free treatment. The volume of the injection differs depending on the location and treatment. Generally, about 0.3 milliliters per square centimeter of skin surface are injected.

    How quickly does the therapy with platelet derived concentrate work?

    In the case of platelet gel treatment, the body’s own regeneration processes are stimulated. The formation of collagen and elastin, the multiplication and immigration of cells of the connective tissue as well as the increase of skin thickness require two to three weeks. However, the effect is only visible and measurable after a few repetitions of the non-surgical procedure with the body’s own substance. Therefore, for a noticeable result, you need to be patient for three to six months. When combined with needling, the results can be seen sooner.

    How often can/should an platelet derived concentrate treatment be repeated?

    The experience of CenterPlast doctors and scientific studies show that a treatment should be repeated at least three times. The newly formed collagen remains in your skin. To slow down the natural aging process of the skin, we recommend repeating the treatment at intervals of six to nine months.

    How long does the result last?

    The effects of the treatment with the platelet derived concentrate are permanent. However, the normal aging processes of the skin are not stopped. It is therefore advisable to repeat the treatment after a certain time. In patients under 40, annual repetition can already achieve the desired effect. In general, a longer effect can be assumed when combined with needling. How you care for your skin after treatment will also affect how long the results last. Therefore, avoid smoking cigarettes, use daily UV protection and appropriate skin care, such as a vitamin A and vitamin C containing skin cream. For more information, tips and answers to frequently asked questions about treatment with the platelet gel and other services, please visit our Anti-Aging and Skin Rejuvenation – FAQ page.

    What studies are there on therapy with the platelet gel?

    The high level of satisfaction of our patients and our experience speak in favour of platelet derived concentrate treatment. In addition, we always keep up to date with the latest scientific findings in order to be able to recommend the best possible treatment for you. In order to investigate the effect of platelet derived concentrate treatment, two groups of patients are ideally compared in a clinical trial (also called a controlled trial). A study should always be examined for possible sources of error. The evaluation of the results of a study requires special knowledge and experience in the conduct of clinical studies. Differences in the preparation of the platelet gel, the administration or the measurement can distort the results. In addition, there are other sources of error, called bias, which can lead to false conclusions.

    For example, if the patients in one group are younger than the patients in another group to which they are being compared, the perceived success may be due to age. This error can be avoided by assigning treatment randomly (also called randomization). If the person measuring or evaluating also has knowledge of the treatment, the measurements may be biased by a preconceived opinion. The secrecy of the treatment carried out prevents such bias. When neither the patient nor the evaluating physician has knowledge of the treatment procedure, it is called a double-blind study.

    Although randomized, controlled, double-blind studies are desirable, they are often not ethically defensible or financially feasible. The effect of the treatment has been proven in numerous controlled studies. The more studies available, the more reliable the recommendations. Scientific guidelines help to assess the quality of these studies (Cochrane Handbook for Systematic Reviews of Interventions, Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidlines). The following scientific publications critically summarize the available literature and confirm the benefits of platelet derived concentrate treatment:

    • Evans AG, Ivanic MG, et al, Rejuvenating the periorbital area using platelet-rich plasma: a systematic review and meta-analysis, Arch Dermatol Res. 2021 Jan 12.
    • Long T, Gupta A, et al, Platelet-rich plasma in noninvasive procedures for atrophic acne scars: a systematic review and meta-analysis, J Cosmet Dermatol. 2020 Apr;19(4):836-844.
    • Maisel-Campbell AL, Ismail A, et al, A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging, Arch Dermatol Res. 2020 Jul;312(5):301-315.

    Who does treatments with the platelet gel?

    Before each treatment, a risk-benefit assessment of all treatment alternatives should be carried out (for example microneedling, filler, autologous fat treatment, lifting operations). Since such a consideration can only be made by a surgeon with the appropriate training and experience, we recommend that you consult a facial surgeon who specializes in the field of cosmetic surgery. He will choose the right technique, which is decisive for the success of the treatment. Doctors call the decision as to which treatment is useful indication. Without a thorough knowledge of all treatment alternatives, the appropriateness of a treatment cannot be assessed. Therefore, it is important to choose an experienced specialist in aesthetic and plastic surgery and medicine with many years of experience.

    Are alternative practitioners allowed to perform platelet gel treatments?

    Alternative practitioners are not allowed to produce the substance according to the German Medicines Act (Münster Higher Administrative Court case reference: 9 A 4073/18). Platelet derived concentrate is a medicinal product within the meaning of Article 2(1) of the Law on medicinal products and Article 2(3) of the Law on transfusions. They are subject to the regulations of pharmaceutical law and require a manufacturing license. In the production of the substance, compliance with strict hygienic regulations is very important. In addition, methods should be used to ensure that platelets are obtained in high concentration and purity. A lot of dexterity and dexterity is necessary in order not to injure the cells during the extraction, the separation and the injection. In the best case, consult a plastic surgeon.

    Risks of therapy with platelet gel

    Since you are treated with your own body cells, allergies and the risk of infection are excluded. The use of closed systems and the observance of strict hygiene regulations prevent contamination or the risk of ignition. Serious complications have not yet been reported after platelet derived concentrate treatment. Minor unwanted side effects may include mild swelling and bruising.

    In which cases may no autohaemotherapy be carried out for health reasons?

    If you regularly take blood-thinning medication, we do not recommend this treatment. If you suffer from cold sores, the treatment should be done only after complete healing. After a vaccination, flu or surgery, protein molecules produced by the immune system can affect the production and effectiveness of platelets. We therefore advise you to wait for about 10 days after a flu or vaccination before performing the treatment.

    Is the cost of autohaemotherapy covered by health insurance?

    Cost sharing by the statutory health insurance companies is excluded, as the health insurance companies only cover the costs of medically urgent treatments. The health insurance funds also only finance treatment methods that have been reviewed by the Federal Joint Committee (G-BA). As of 2021, there are over 10,000 scientific publications on the application areas and effectiveness of the method. However, it often takes years or decades until the scientific facts are acknowledged by the Federal Joint Committee (G-BA). You can find out more on our page about the benefit obligations of the health insurance funds Benefit obligations of the health insurance funds.

    Before and after pictures of the treatment method with platelet derived concentrate

    This therapy is successfully used for a wide variety of purposes. The presentation of before and after pictures of procedures for aesthetic purposes on internet sites is not permitted by law. In the context of a personal consultation, you can ask the treating doctor to show you the before and after photos of platelet gel therapies, so that you get a realistic picture of the achievable success of the treatment. Talk to your doctor about this. For more information on the subject, see the corresponding page on before and after pictures. This is located in the menu category “About us” in the tab “Quality”.

    Experience reports on the treatment with platelet gel

    The picture above shows a selected testimonial of treatment with platelet derived concentrate at the Centerplast practice. You can find more reviews as well as patient testimonials on the Testimonials page.

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    The author

    Dr. Adelana Santos Stahl

    “Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

    Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best.She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery.From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris.A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience.Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP.She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.

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