2017-18 HSC Section 4 Green Book

Potential of Topical and Injectable GFs for Skin Rejuvenation

Fabi, Sundaram

Fig. 10 ( A ) A 57-year-old woman before ( left ) and after ( right ) submuscular injection of 2 cc platelet-rich fi brin matrix (PRFM) (Selphl, Aesthetic Factors, Wayne, NJ) to each lower eyelid using a 27 G 38 mm blunt microcannula, followed by intradermal injection of 0.5 cc PRFM to each side using a 30 G needle. The image on the right was taken 94 days after the fi rst treatment session and 73 days after the second session. On a 5-point assessment scale for patient satisfaction, the patient reported that she was “ Extremely Satis fi ed ” (the highest score on the scale) with the result. Three-dimensional imagingwith Can fi eld Vectra system. Courtesy of Hema Sundaram, MD. ( B ) Same patient before ( left ) and after ( middle and right ) injection of 2.5 cc PRFM (Selphl) to each lower eyelid. Middle image is 21 days after the fi rst treatment session. Right image is 94 days after the fi rst session and 73 days after the second session. Three- dimensional imaging with Can fi eld Vectra system. Courtesy of Hema Sundaram, MD.

Adverse Effects and Safety Considerations

examined, while the VEGF receptor, KDR, was detected only in three melanoma cell lines. 55 Exogenously added VEGF (10 ng/mL) was able to stimulate up to 40% increased prolifera- tion in these melanoma cells. In contrast, Graeven et al found exogenous VEGF had no signi fi cant effects on melanoma cell proliferation or on production of a transcriptional target for VEGF. 57 And another study of human tumor cells, including squamous cell carcinomas of the head and neck and melano- mas, found that VEGF treatment of tumor cells expressing the VEGFR-1 receptor actually inhibited cell proliferation and migration. 58 To date, there have been no investigations of suf fi cient evidence level to indicate that topical or injectable GFs have either a stimulatory or inhibitory role in human carcinogen- esis. An evidence-based approach requires controlled studies of balanced mixtures of multiple GFs that are applied topi- cally or via injection to human tissue, rather than extrapola- tion from anecdote, or from animal studies that employ supraphysiological concentrations of one or a few GFs. Pro- duction and activity of the body ’ s endogenous GFs are closely controlled by positive and negative feedback mechanisms. It is reasonable to infer that autologous and exogenous GF mixtures with a similar composition may be in a similar state of physiological balance, and also subject to some of the same control mechanisms. 8 Our ethical responsibility toward pa- tients mandates continuous monitoring of the safety of all therapeutic interventions. This is particularly so for aesthetic

All topically applied products carry the risk of irritant or allergic contact dermatitis, as do injectable preparations of PRP, which rely on animal-based thrombin and other addi- tives. Because some malignant cells have receptors for certain GFs, and some GFs may increase cellular proliferation, there has been concern as to whether GFs might have the potential for tumorigenesis or promotion of cellular atypia. 55,56 Others postulate that exogenous GFs have a normalizing effect on the growth and differentiation of target cells. Studies of the effects of individual GFs on animal skin and on human tumor cells have shown con fl icting results. The validity of extrapo- lating these data to topical or injectable application of GF mixtures to human tissue remains to be clari fi ed. In one study, EGF, TGF- α and suramin (GF inhibitor) were applied to murine skin for nine days. It was found that TGF- α increased creatine phosphokinase (CPK) activity. EGF and TGF- α both induced a transition from the CPK MM to CPK BB isoenzyme. 56 The signi fi cance of these fi ndings is that the phosphocreatine/CPK system is believed to play an important role in the normal physiology of skin and in pathophysiologi- cal conditions such as psoriasis and carcinogenesis. Histo- pathological evaluation showed abnormal differentiation and distribution of keratinocytes. In a study of human tumor cells using the reverse transcriptase polymerase chain reaction, VEGF expression was found in all 15 cell lines that were

Facial Plastic Surgery Vol. 30 No. 2/2014

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