A new source of aging?

Rejuvenating the periorbital area using platelet-rich plasma: a systematic review and meta-analysis

Intradermal injection of autologous platelet-rich plasma (PRP) is a non-surgical cosmetic therapy to rejuvenate the periorbital area pathologies of wrinkles, periorbital hyperpigmentation (POH), and photoaging. The past decade has seen the adoption of this novel therapy around the world. This is the first systematic review and meta-analysis evaluating PRP treatment of periorbital pathologies. This is a PRISMA compliant review that includes a comprehensive search of the databases Cochrane Library, Ovid Medline, Ovid Embase, and clinicaltrials.gov. The search was performed in June 2019 to obtain all peer-reviewed articles published in English that describe the application of PRP to periorbital pathologies. A meta-analysis of patient satisfaction was performed for randomized controlled trials. Nineteen studies treating 455 patients (95% female, age range 28-60) were included. Studies were categorized based on reported outcomes: wrinkles (11 studies), POH (7 studies), and photoaging (6 studies). Patients were treated a mean of 3 times (range 1-8) in mean intervals of 23 days (range 14-56 days). Follow-up averaged 3 months (range 1-6 months). Meta-analysis of 3 randomized controlled clinical trials (RCTs) shows that patients treated with PRP have increased satisfaction above controls of saline, platelet-poor plasma, mesotherapy, and as an adjunct to laser therapy (overall effect p = 0.001, heterogeneity I² = 64%). PRP treatment of periorbital area pathologies results in histologic improvements of photoaging, subjective satisfaction score increases, and blind evaluator assessments of rejuvenated skin appearance. Future studies are needed to address limitations of the current literature and should include long-term follow-up, delineation of the POH etiology that is treated, RCTs with low risk of bias, and be absent conflicts of interest or industry sponsors.Trial registration: Prospero Systematic Review Registration ID: CRD42019135968.

Reactive molecule species and antioxidative mechanisms in normal skin and skin aging

Reactive oxygen and nitrogen species (ROS/RNS) which may exist as radicals or nonradicals, as well as reactive sulfur species and reactive carbon species, play a major role in aging processes and in carcinogenesis. These reactive molecule species (RMS), often referred to as 'free radicals' or oxidants, are partly by-products of the physiological metabolism. When RMS concentrations exceed a certain threshold, cell compartments and cells are injured and destroyed. Endogenous physiological mechanisms are able to neutralize RMS to some extent, thereby limiting damage. In the skin, however, pollutants and particularly UV irradiation are able to produce additional oxidants which overload the endogenous protection system and cause early aging, debilitation of immune functions, and skin cancer. The application of antioxidants from various sources in skin care products and food supplements is therefore widespread, with increasingly effective formulations being introduced. The harmful effects of RMS (aside from impaired structure and function of DNA, proteins, and lipids) are: interference with specific regulatory mechanisms and signaling pathways in cell metabolism, resulting in chronic inflammation, weakening of immune functions, and degradation of tissue. Important control mechanisms are: MAP-kinases, the aryl-hydrocarbon receptor (AhR), the antagonistic transcription factors nuclear factor-κB and Nrf2 (nuclear factor erythroid 2-related factor 2), and, especially important, the induction of matrix metalloproteinases which degrade dermal connective tissue. Recent research, however, has revealed that RMS and in particular ROS/RNS are apparently also produced by specific enzyme reactions in an evolutionarily adapted manner. They may fulfill important physiologic functions such as the activation of specific signaling chains in the cell metabolism, defense against infectious pathogens, and regulation of the immune system. Normal physiological conditions are characterized by equilibrium of oxidative and antioxidative mechanisms. The application of antioxidants in the form of 'cosmeceuticals' or systemic 'nutraceuticals' should aim to support a physiologically balanced oxidation status in the skin.

Quantitative dermal measurements following treatment with AirGent

BACKGROUND

As an alternative to other minimally-invasive approaches to facial rejuvenation, enhancement and treatment of the dermis with a compressed air molecule of hyaluronic acid (HA) is a promising method in that it lacks some of the drawbacks of other procedures. The novelty of these systems, one of which is tested in this study, is based on the supposition that jet lateral dispersion of HA produces both instant dermal augmentation and specific wound-healing processes, leading to its long-term dermal thickening.

OBJECTIVES

The authors report on the efficacy and safety of the AirGent system (PerfAction, Rehovot, Israel), which is a renewal system designed to initiate a wound-healing process in the dermal layer. It is a computer-guided system that delivers treatment through compressed air molecules of HA to the dermal layer of the skin.

METHODS

The authors treated 20 patients (a total of 105 treatment sessions) with the AirGent system between May 2008 and November 2008. Each patient received three treatments at three- to four-week intervals. Each patient's skin thickness was measured with ultrasonography pretreatment, immediately after each session, and at six months posttreatment.

RESULTS

Seven days after the last procedure, an increase in skin thickness was observed in all patients. The most significant differences were noted in the upper lip area, where the thickness had increased by an average of 1.3 mm. Six months after the last session, an increase in skin thickness was still noted in most patients, at which time the biggest difference was noted around the eyes, where the skin remained thicker by an average of 0.77 mm over baseline. According to the results of the Global Improvement Assessment questionnaire, at the six-month follow-up to evaluate their satisfaction with the long-term results, at least 59.9% of patients still noted at least a slight improvement in their appearance.

CONCLUSIONS

Although a small group of patients and a relatively short period of observation limit the scope of our conclusions, the data show that the AirGent system is efficacious in producing increases in skin thickness that correlate with at least a substantial or slight improvement of appearance, as reported by the patients themselves.