Surgical Challenge
Scarring is a frequent consequence of acne. The improvement in atrophic acne scars by dermal fillers is limited by the cost of these products. Platelet poor plasma (PPP) gel has been used as a dermal filler for the correction of facial wrinkles, tear trough deformity and recently for the boxlike scars of chickenpox.[1]
Solution
We have devised a cost-effective autologous platelet-rich plasma (PRP) dermal filler gel for the correction of rolling and boxcar subtypes of soft atrophic acne scars based on the thermal denaturation and polymerization of plasma proteins. PRP is drawn into insulin syringes that are then placed in a kidney tray containing hot water at 65°C for a few minutes until the contents turn cloudy yellow indicating gel formation [Figure 1a] and its consistency was checked [Figure 1b]. The atrophic rolling and boxcar acne scars [Figure 2a] were lifted by intradermal injection of PRP gel filler resulting in a marked improvement in the appearance of atrophic scars [Figure 2b] due to tissue augmentation and remodeling of the extracellular matrix.
Figure 1.
(a) Plasma proteins in insulin syringes containing PRP coagulate into a gel when placed in a kidney tray containing hot water for a few minutes, indicated by the contents turning cloudy yellow. (b) Consistency of the PRP dermal filler gel
Figure 2.
(a) Atrophic rolling and boxcar acne scars before treatment. (b) Improvement in atrophic acne scars 5 weeks after the injection of PRP dermal filler gel
Though there is a solitary report of the use of PRP gel as a dermal filler for prominent nasolabial folds by aesthetic surgeons,[2] it has not been used previously as a filler in patients with atrophic acne scars.
Tissue augmentation by PRP dermal filler gel in the case of soft atrophic acne scars not only has a volume effect with an immediate improvement in contour but may also induce remodeling of extracellular matrix by the activation of platelet-derived growth factor and various cytokines.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Dashore S, Dashore A. Platelet-poor plasma-based biofiller: An innovative alternative to expensive hyaluronic acid-based fillers for treatment of chicken pox scars. J Am Acad Dermatol. 2019 doi: 10.1016/j.jaad.2019.07.100. S0190-9622(19)32493-4. doi: 10.1016/j.jaad.2019.07.100. [DOI] [PubMed] [Google Scholar]
- 2.Tosun Z, Koplay TG, Aktan M, Duman S, Akdag O, Karamese M. Abstract: Filling prominent nasolabial fold applying platelet rich plasma (PRP) Gel. Plast Reconstr Surg Glob Open. 2016;4(9 Suppl):205. [Google Scholar]