Ablative Fractional LASERs in combination with triamcinolone or platelet rich plasma to treat scars and Keloids Dr. Ahmed A. Youssef, EBDV MD Head of Dermatology & LASERs Dept. (QMC , Kuwait) Diplomate of European Board of Dermatology & Venereology Diplomate of American Board of LASER Surgery Diplomate of American Board of Hair Restoration Surgery

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Disclosure No current conflicts of interest in the subject or materials presented

I N T R O D U C Atrophic scars are known for being difficult to treat especially areas with poor blood supply e.g. tip of nose. Fractional carbon dioxide laser resurfacing (FxCR) has a remarkable effect on scar remodeling, and autologous platelet rich plasma (PRP) is known to enhance wound healing. We hypothesized that combined treatments by FxCR and PRP gel would manage atrophic scars more effectively.

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A I M O F W R K Compare different parameters for centrifugation and separation to get the best PRP Gel form Determine the value of adding PRP gel in healing after FxCR as regards down time for healing and final outcome. Go further with clinical application of PRP Gel to prove efficacy in promoting healing after ablative LASER resurfacing

Materials & Methods Nineteen patients with atrophic scars were treated by FxCR with variable settings for 5 sessions at 6 weeks interval : Power 6 – 10 W Spacing 300 – 400 mm (Density 22.8% - 17.1%) Dwell time 600 – 1200 ms Stack 5

Materials & methods PRP was prepared from 9 ml blood collected in a tube prefilled with 1 ml anticoagulant solution followed by centrifugation 500 x g for 10 minutes, where PPP was separated, then 1000 x g for 7 minutes to separate PRP.

Materials & methods PRP gel is allowed to form as platelet rich fibrin matrix membrane (PRFMM) by adding platelet poor plasma (PPP)  To calcium gluconate 10% for induction of fibrin mesh network polymerization a sterilized dish and leaving it for 20 minutes in fridge at 4 0C . PRP gel membrane (PRFMM) was applied immediately after each session for treated areas and kept for 5 days.

Materials & methods

Patient with Rhinoplasty previous to Filler complication Before 6 months after last session Courtesy of Dr. Ahmed A. Youssef Patient with Rhinoplasty previous to Filler complication

Patient with Rhinoplasty previous to Filler complication Before 6 months after last session Patient with Rhinoplasty previous to Filler complication Courtesy of Dr. Ahmed A. Youssef Courtesy of Dr. Ahmed A. Youssef

Patient with Rhinoplasty previous to Recent Trauma Before 6 months after last session Courtesy of Dr. Ahmed A. Youssef Patient with Rhinoplasty previous to Recent Trauma

Patient with Rhinoplasty previous to Recent Trauma Before 6 months after last session Patient with Rhinoplasty previous to Recent Trauma Courtesy of Dr. Ahmed A. Youssef Courtesy of Dr. Ahmed A. Youssef

Before 6 months after last session Courtesy of Dr. Ahmed A. Youssef

Courtesy of Dr. Ahmed A. Youssef Before 6 months after last session

Axillary Brachioplasty SCAR Before 6 weeks after 2 sessions only Courtesy of Dr. Ahmed A. Youssef Axillary Brachioplasty SCAR

Axillary Brachioplasty SCAR Before 6 weeks after LAST session Axillary Brachioplasty SCAR after 2 sessions only Courtesy of Dr. Ahmed A. Youssef

Before 6 months after last session Courtesy of Dr. Ahmed A. Youssef Multiple atrophic & hypertrophic scars after roaccutane Treatment & trial for peeling

Discussion Significant improvement for all cases with signs of revitalization : Elasticity Colour Texture No adverse reactions other than : Itching (usually mild within 2 weeks after session). Prolonged erythema (usually mild to moderate; subsides 3 months after last session). Transient hyperpigmentation (subsides after last session).

Conclusion PRP gel prepared in the form of PRFM provides a good scaffold for scar remodeling after FxCR. It acts as a reservoir for delivering growth factors (which actually have short half life) from platelets and maintaining platelets concentration for enhancement of post FxCR ablative wound care.

Conclusion PRP Preparation technique & parameters have not been standardized yet; it seems from our trials that parameters affect both concentration and efficacy of PRP Further studies are needed to standardize PRP gel application after FxCR in atrophic scars. We are carrying on further studies to standardize PRP gel application after FxCR in atrophic scars and broaden the indications for such technique.

Courtesy of Dr. Ahmed A. Youssef

Courtesy of Dr. Ahmed A. Youssef

Courtesy of Dr. Ahmed A. Youssef

Courtesy of Dr. Ahmed A. Youssef

Courtesy of Dr. Ahmed A. Youssef

Courtesy of Dr. Ahmed A. Youssef

شكـــــراَ Grazie Mille Gracias Obrigado Spasibo Thank you Merci Beaucoup Grazie Mille Gracias Obrigado Spasibo