Patient Satisfaction and Clinical Effects of Platelet-Rich Plasma on Pattern Hair Loss in Male and Female Patients.

Introduction Hair loss is a widespread condition in both genders. Over the past decade, platelet-rich plasma (PRP) has become a common treatment for hair loss. Our goal was to analyze patient satisfaction and the clinical effects of PRP on male and female pattern hair loss. Methods Over a period of 12 months, we treated a total of 56 patients for androgenetic alopecia with PRP. All of these patients were included in this study; 15 cc of whole blood was spun in an ACP double syringe (Arthrex Inc., Naples, Forida) for five minutes. The yielded 5 to 6 cc of PRP were then injected into the scalp. Forty-nine patients were treated with a series of three injections at monthly intervals, three patients with a series of four injections, two patients with a series of five injections, one patient was treated with a series of seven injections, and one patient with a series of eight injections. Follow-ups were conducted one month after the last treatment. A self-drawn questionnaire was used to assess the satisfaction and clinical results from the patient's and the clinician's perspectives. Results The average age was 41 years (20-68 years). Fifty-seven percent of all patients were male and 43% female. In total, the patients were satisfied with the treatment results. The average score was 7.29 on a scale from 0 to 10. The clinician's rating was similar (6.46). Moreover, with an average score of 8 on a scale from 0 to 10, it is very likely that the patients will recommend PRP treatments to friends. The probability of occurrence of clinical effects among the entire study population was reported as follows: improvement in hair density (patient's rating: 64%; clinician's rating: 46%), thickness (38%; 45%), quality (46%; 54%), sheen/lustre (27%; 21%), new hair growth (57%; 68%), less hair loss (48%; 20%), other positive effects (5%, 2%), no effects (4%; 4%), negative effects (0%; 0%). Conclusion Our study revealed encouraging results for the treatment of male and female pattern hair loss with PRP. The autologous treatment was rated with high satisfaction scores and can be considered a safe and effective treatment modality.

Can Platelet-Rich Plasma Reduce the Burden of Inflammatory Skin Diseases Such as Psoriasis and Atopic Dermatitis?

Objective In this study, our aim was to investigate the clinical effects of platelet-rich plasma (PRP) on the skin of patients suffering from plaque psoriasis or atopic dermatitis. Methods Over a period of 53 months, we treated a total of 40 patients for inflammatory skin diseases with PRP. All of these patients were included in this study; 5-6 ml of PRP were prepared with the autologous-conditioned plasma (ACP) double syringe and injected subdermally. Follow-ups were conducted at three, six, nine, and 12 weeks after treatment. Besides the lesion size, Psoriasis Area and Severity Index (PASI) and Eczema Area and Severity Index (EASI) were also calculated. Data were evaluated statistically at a significance level of p≤0.05. Results A total of 30 patients were treated for plaque psoriasis. The elbow area represented the most common area of treatment (17 cases). The average lesion size decreased from 8.2 cm² to 0.3 cm² (p<0.00001). Of note, 80% of all patients achieved complete remission (PASI100) at the last follow-up. The remaining 20% reached at least PASI70. Ten patients were treated for atopic dermatitis. In six cases, efflorescences on patients' arms were treated, and in four cases, patients' legs were treated. The average lesion size decreased from 8 cm² to 0.155 cm² (p<0.00001). Notably, 50% of all patients achieved complete remission (EASI100) at the last follow-up. The other half reached at least EASI70. In all cases, the lesion size decreased progressively. No adverse events were reported. Conclusion Our study revealed encouraging results for both psoriasis and atopic dermatitis. The autologous treatment was safe and effective in all patients. Further studies are required to validate these initial findings.

Stromal vascular fraction and emulsified fat as regenerative tools in rejuvenation of the lower eyelid area.

In the lower eyelid area, dermal melanocytosis, fine lines, skin atrophy, dryness, and loss of subcutaneous fat tissue represent the initial signs of aging. Beside the addition of volume, adipose tissue injections can also improve pigmentation and skin texture. Clinical studies of simultaneous stromal vascular fraction (SVF) and emulsified fat transfers have not been reported so far. Our aim was to investigate the clinical results of transferring SVF and emulsified fat into the lower eyelid area. A total of 16 patients underwent tumescent liposuction and injection of SVF and emulsified fat into the lower eyelid area. For preparation of SVF and emulsified fat, ACP double syringes with 2.4, 1.4, and 1.2 mm connectors, and a swing-out rotor centrifuge, were used. At follow-up, improvements on before and after pictures were rated by the treating physician and two independent physicians, using the global aesthetic improvement scale (GAIS). Clinical outcomes were rated as exceptional, very improved, or improved in all patients, with an average GAIS score of 1.6. No serious adverse events occurred. Our initial results suggest that SVF and emulsified fat are safe and effective tools for skin rejuvenation and correction of volume deficiencies in the lower eyelid area. More studies need to be conducted to corroborate these encouraging findings.

Can hydrogel dressings reduce patients' discomfort and side effects of facial platelet-rich plasma injections?

The literature shows that facial injection of platelet-rich plasma (PRP) is a safe and effective treatment modality. Serious adverse effects have not been reported so far. Nevertheless, side effects such as redness, edema, bruising, pain, pruritus, and heat sensation have been reported. Our goal was to assess the potential effects of hydrogel dressing after injection of PRP. PRP was prepared using an ACP double-syringe system and applied on face by intradermal microdeposit injections. One half of the face was covered with a cooled (20°C) hydrogel dressing for 20 minutes before and after PRP injection. Patients rated the levels of pain separately for both sides. Physician and patient rated the overall appearance of the skin, redness, swelling, bruising, and number of bruises straight after the procedure. At 6-month follow-up, the physician rated the global aesthetic outcome. Needle prick-induced pain and edema were rated less on the hydrogel side. Our results demonstrate a significant reduction of patient's discomfort and side effects through application of hydrogel dressings. Recovery has been accelerated and the overall appearance of the skin straight after the procedure has been rated significantly better than without dressing application. At 6-month follow-up, the global aesthetic improvement was rated equally on both sides.

Successful Treatment of Alopecia Areata Barbae with Platelet-rich Plasma.

Alopecia areata (AA) is a frequent autoimmune disorder in which inflammatory cells attack the hair follicles. AA affecting the beard area is well known and is referred to as alopecia areata barbae (AAB) when involvement is limited exclusively to the beard. Currently, no guidelines are established for specific therapeutic approaches for this condition. We present a case of a healthy 30-year-old male suffering from AAB. Three injections of platelet-rich plasma (PRP) with six-week intervals were applied. Stabilization of the condition was noted at the first follow-up (before the second injection), initial minimal hair regrowth was noted at the second follow-up (before the third injection) and robust regrowth at the one-year follow-up. To our knowledge, this case is the first report of a successful treatment of AAB using PRP. PRP represents a new, safe and potentially effective treatment option for AAB. More studies will be necessary to determine the efficacy of this treatment compared to conventional therapy.

Platelet-rich Plasma for Skin Rejuvenation and Treatment of Actinic Elastosis in the Lower Eyelid Area.

Background Treatment of the lower eyelid region to rejuvenate the skin or treat actinic elastosis often proves difficult. Established treatment options, such as hyaluronic acid injections, botulinum toxin injections, microneedling, skin resurfacing (microdermabrasion, chemical peel (exfoliation), laser treatment), as well as blepharoplasties and autologous fat transfers, can be associated with significant risks and increased patient burden. Furthermore, they may not be effective for treating the signs of skin aging or actinic elastosis, including dark rings under the eyes, a lack of volume and cutis laxa. A minimally invasive treatment approach which visibly improves the above-mentioned conditions and which involves minimal risk and patient burden would be a desirable alternative. Materials & methods Twenty patients were treated a total of three times at monthly intervals with PRP (platelet-rich plasma). The patients were examined on the days of treatment and one month after the third injection. The PRP was obtained directly prior to treatment using the Arthrex ACP double syringe at the point of care. The injections (2 ml PRP per side) were administered laterally using 27 G 38 mm cannulas. Accurate photographic documentation and skin elasticity measurements using a cutometer were performed to objectify the subjective assessments from the patient and practitioner questionnaires. Results A progressive improvement in the esthetic outcome and a high level of patient satisfaction were determined. The cutometer measurements showed a statistically significant higher level of skin firmness (due to increased collagen production) and a statistically significant increase in skin elasticity (thanks to increased elastin production). Other than the anticipated visible swelling directly after the PRP injection, no other undesirable side effects or complications occurred. The typical burning sensation during the injection had not been reported. Conclusion The results indicate that a series of PRP injections in the lower eyelid region is a safe, efficient, virtually pain-free, simple and rapid treatment option for an area with otherwise limited treatment alternatives.

The Psychologic and Psychosocial Impact of Otoplasty on Children and Adults.

BACKGROUND: In previous studies, our research group already evaluated the impact of aesthetic surgery on "quality of life" (QoL). This study evaluates QoL factors and perceptions of well-being after otoplasty as a single indication. METHODS: Eighty-one patients who underwent otoplasty were divided into three age groups: Youth 1 (Y1) = 8-12 years (n = 17), Youth 1 (Y2) = 13-17 years (n = 13), and Adult ≥18 years (n = 51). For competitive analysis, 2 groups of tests were used: a standardized self-assessment test on life satisfaction (FLZ(M)), the Glasgow Benefit Inventory (GBI), the standardized Rosenberg Self-Esteem Scale (RSES), the standardized Freiburg Personality Inventory (FPI-R), the Patient Health Questionnaire 4 (PHQ-4), and a self-developed and indication-specific questionnaire for "Adult" group. The tools for the groups Y1 and Y2 were: PHQ-4, KINDL(R), the Glasgow Child Benefit Inventory (GCBI), and a self-developed and indication-specific questionnaire either. RESULTS: Our data bared numerous significant improvements on patients' QoL. In the items "friends" (P = 0.036) and "freedom of anxiety" (P = 0.034) of the FLZ(M), important improvements were found. In section "satisfaction with appearance" (body image), the items "hair" (P = 0.003) and "ear" (P = 0.034) were to point out. The RSES (P = 0.001) and the FPI-R (P = 0.035) data indicated a well-balanced emotional stability. The results of the GBI/GCBI (P = 0.000/P = 0.000) showed a higher QoL of postsurgery patients. The data of the KINDL questionnaire provided increasing values in the modules "friends" (P = 0.033) and "total score" (P = 0.040) for boys of the ages 8 to 12. For all age groups, there was a less affinity to depression (PHQ-4) and a high satisfaction with the aesthetical result (indication-specific questionnaire). CONCLUSIONS: This study showed higher QoL in all age groups by using standardized tools in comparison with the norm data. The knowledge of postoperative psychologic benefits, such as "satisfaction with appearance" (body image) and "different areas of life," self-confidence, and self-esteem as well as lower level of depression support meaningfulness of otoplasty. LEVEL OF EVIDENCE: Therapeutic, III: Retrospective cohort or comparative study.

The free osteofasciocutaneous fibula flap: clinical applications and surgical considerations.

INTRODUCTION: The aim of this study was to investigate the intraoperative findings, postoperative complications, donor site morbidity and patients' Quality of Life in order to evaluate the usefulness of the free osteofasciocutaneous fibula flap in the reconstruction or construction of a mandibula, neophallus, lower leg or forearm. MATERIALS AND METHODS: 104 patients were treated with free osteofasciocutaneous fibula flaps in our clinic. 23 for mandible reconstruction, 66 for neophallus reconstruction, 9 for lower leg reconstruction and 6 for forearm reconstruction. These patients were asked to answer a questionnaire and to be present for a clinical and a radiological examination in our department. In addition, their previous records were evaluated retrospectively. RESULTS: The dimension of the surface of the skin island was 178.6 cm(2) (72-352 cm(2)) in average and the average length of the fibular bony part was 15.4 cm (10-23 cm). The most frequent and severe complication was skin island edge necrosis (n=7); no total flap necrosis was found. Donor-site morbidity was low, since no joint instability could be reported. Quality of Life was improved according to the standardised FLZ(M) questionnaire. CONCLUSION: Advantages of free osteofasciocutaneous fibula flaps were the wide cortical bone and the relative constant anatomy, the long pedicle, flat, uniform and sufficient large and pliable skin island, as well as the good blood circulation also by massive modelling of the skin and bone part. The skin island could be harvested large enough in order to reconstruct extended soft-tissue defects in the face and the extremities as well as to construct neophallus in its normal size without any restrictions. The lower leg donor-site morbidity was moderate and can be readily covered with a sock in patients' everyday life common activities. Finally, in our hands, the utilisation of the free osteofasciocutaneous fibula flap is the best possible therapy for these difficult composite reconstructions.