Is it recommended to combine Platelet Rich Plasma with Hyaluronic Acid- 
for Therapy?

A general interest has recently arisen concerning the combination of platelet rich plasma (PRP) and Hyaluronic acid (HA) therapies. Indeed, PRP may be used as a standalone treatment or as a biological adjunct to other biomaterials, such as HA, collagen, bone substitutes, stem cells etc.

Combining these two techniques may create a synergistic effect, as the HA acts as a scaffold upon which the PRP induces collagen and adipocyte generation. This will result in both augmentation and maintaining of tissue volumizing effect. Promising aesthetic results have been demonstrated using this technique, and studies are ongoing (1). The combination of PRP and filler provides a custom designer procedure that leaves patients looking more youthful for longer than traditional procedures.

When coming to choose the HA for optimal results, a cross linked HA should be chosen for the combination with PRP as the two types of treatments are aimed for different purposes; they supplement each other to give the best final outcome of a more youthful looking face. The cross linked HA fills specific lines and folds; PRP improves overall volume, fullness, and skin tone.

As there are different HA available in the market, as mentioned above, a major criteria which plays a crucial role in this combination, is the exact type of HA chosen. Today there are various kinds of HAs in use for aesthetics soft tissue augmentation. However, these agents have demonstrated variable degrees of resorption, requiring repeat injections in order to maintain volume. Different HA products exhibit different cross linking degree and these modifications have a significant effect on the filler’s properties. Increasing cross-link density strengthens the effect of the HA gel and the combination with PRP will be more solid and long lasting. A network of cross-linked HA retains its structure for a longer period of time (2).

Another important factor relates to the exact timing of HA addition into the PRP.

As our goal with the PRP treatment is to accelerate the healing process and reduce the pain accompanied with the injury, we need to isolate and purify the main cells that are known to adverse the anabolic effect, and help with the rejuvenation path. These are mainly the platelets which upon activation will release the growth factors and other bioactive proteins stored in their granules. In the presence of HA, platelets will get activated to release their granules content (growth factors and bio-effecting proteins). If the HA will meet the whole blood, i.e before PRP separation/centrifuge, it will cause the activation of various blood cells leading to the release of catabolic mediators as well.

In light of the above we recommend that the HA should be added only into the separated PRP phase rather to the whole blood. In addition, it is highly important to choose the suitable cross-linked HA for this combination. Hence, the appropriate way will be adding the cross-linked HA in the purified PRP.

References:

1. Platelet-Rich Plasma in Cosmetic Surgery, Kang R.S. et al., Int J Otorhinolaryngol Clin 2013.

2. Comparative Physical Properties of Hyaluronic Acid Dermal Fillers Kablik J. et al., Dermatol Surg. 2009.

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