Scarring is a natural process that unfolds as wounds heal. If a lesion is more than 5 mm deep or takes longer than 3-4 weeks to repair, the healing process is likely to leave a scar. In the presence of a skin opening, collagen fibers rapidly divide to protect the body from harmful pathogens. Platelets clot blood to form a scab which temporarily closes the wound while the underlying skin regenerates. New collagen fibers cross-link and form a pronounced alignment in one direction. The directional structure of new skin forms a scar because of it’s contrast to the random basket weave of normal tissue.
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Scar Formation and Treatment Options
Traumatic scars from injuries or surgery persist throughout one’s lifetime. For some individuals, scars may attract unwanted attention or, depending on the scar location, it may be bothersome for cosmetic reasons. Recent medical advancements include techniques to help individuals with unwanted scarring such as filler injections, chemical peels and ablative lasers. Fillers such as hyaluronic acid, calcium hydroxylapatite, and silicon are used with atrophic scars.¹ A clinician injects the filler below the surface of the skin to help bring the scar up to the level of surrounding tissue. Chemical peels work like dermabrasion, they helpful reduce the appearance of superficial scars by damaging the first layer of skin. Ablative and nonablative lasers working a similar fashion by destroying the epidermis to a controlled depth.
Platelet Rich Plasma in Adjunct with Scar Treatments
Clinicians looking to improve outcomes for patients with traumatic scars are beginning to incorporate platelet rich plasma (PRP) into scar treatment procedures. PRP can help rebuilt structures by increasing the level of bioactive proteins, known as growth factors, in damaged tissues. Platelet rich plasma is prepared from the patient’s own blood, so there is zero risk of allergic reaction. Whole blood is subjected to differential centrifugation to separate red blood cells, white blood cells, platelet poor plasma, and platelet rich plasma. If prepared correctly, the final product is a concentrated serum with platelet levels 6-7 times that of whole blood.
Platelets are non-nucleated fragments of cytoplasm produced in the bone marrow by megakaryocytes. They contain 17 known growth factors which initiate healing by signalling to surrounding cells. Growth factors such as vascular endothelial growth factor, epidermal growth factor, and connective tissue growth factor increase mitosis and migration to heal damaged tissues.² Of particular interest for scar resurfacing, transforming growth factor signals surrounding cells to increase collagen synthesis.
Study Finds Promising Results: PRP Reduces Scar Appearance
Recent research suggests the combination of laser resurfacing and PRP therapy can help recruit melanocytes to the surface of the skin for scar repigmentation. Italian researchers utilized PRP in conjunction with fat grafts and fractional nonablative laser to treat traumatic scars in a 2012 study. The randomized, controlled trial involved 60 patients split into three groups; group A was treated with fat grafts mixed with PRP, group B was treated with nonablative laser, and group C was treated with both procedures. PRP was prepared by drawing 18 ml of blood in the presence of an anticoagulant (sodium citrate), centrifuged at 1100 g for 10 minutes and then activated with an autologous thrombin. The activated PRP was added to centrifuged fat and injected below the surface of the scar for patients in groups A and C.³
Groups B and C received fractional nonablative laser resurfacing from an erbium:glass rod attached to a xenon flash. Four sessions were administered which consisted of 3-4 passes of 1540 nm wavelength laser and an average energy fluence of 20-40 J/cm². Though scars varied in size and location, the same doctor administered all treatments. Patients were evaluated by an independent physician after each laser session and six months after treatment. Scar appearance was assessed according to the Manchester Scar Scale (MSS) which includes color, contour, and texture among other parameters. Results showed significant benefit for procedures augmented with platelet rich plasma. Patients in group C saw the best results with a combination of laser with PRP and fat grafts.³
Better Outcomes with PRP Therapy
Study after study has confirms that PRP augments a patient’s ability to re-form damaged tissues without negative side effects. The potency of PRP comes from the massive release of growth factors once the serum is activated. Platelets start releasing growth factors within 10 minutes of activation and excrete 95% of pre-synthesized growth factors within the first hour of activation. Platelets continue to synthesize growth factors for a week to ten days, then they are removed from the bloodstream.³
Growth factors are vital for tissue repair. Key growth factors in epithelial cells include: platelet derived growth factor and transforming growth factor both of which regulate collagenase secretion and collagen synthesis; vascular endothelial growth factor increases angiogenesis and stimulate mitogenesis in endothelial cells; and epidermal growth factor which stimulates endothelial chemotaxis, regulates collagenese secretion and stimulates epithelial mitogenesis.²
PRP is simple to prepare, safe and effective wound healing agent. Clinicians who incorporate PRP into their practice see better outcomes with effective preparation and activation techniques. Additional studies have found PRP to be an effective adjunct therapy in treating acne scars, alopecia, caesarean section incisions, and wrinkles.
- Wollina U, Goldman A. Fillers for the improvement in acne scars. Clinical, Cosmetic and Investigational Dermatology. 2015;8:493-499. doi:10.2147/CCID.S86478.[ncbi]
- Dhurat R, Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author’s Perspective. Journal of Cutaneous and Aesthetic Surgery. 2014;7(4):189-197. doi:10.4103/0974-2077.150734.[ncbi]
- Cervelli V, Nicoli F, Spallone D, et al. Treatment of traumatic scars using fat grafts mixed with platelet-rich plasma, and resurfacing of skin with the 1540 nm nonablative laser. Clin Exp Dermatol. 2012;37(1):55-61.[ncbi]
- LeBrasseur N. Platelets’ preset lifespan. The Journal of Cell Biology. 2007;177(2):186. doi:10.1083/jcb.1772rr5. [ncbi]
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