1. 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

2. Attention Photographic pictures and Videos are not allowed for keeping patient’s privacy Thank you

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

4. 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.

5. I N T R O D U C

6. I N T R O D U C

7. I N T R O D U C

8. 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

9. 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% %)
Dwell time 600 – 1200 ms
Stack 5

10. 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.

11. 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.

12. Materials & methods

13. 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

14. 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

15. 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

16. 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

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

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

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

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

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

22. 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).

23. 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.

24. 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.

25. Courtesy of Dr. Ahmed A. Youssef

26. Courtesy of Dr. Ahmed A. Youssef

27. Courtesy of Dr. Ahmed A. Youssef

28. Courtesy of Dr. Ahmed A. Youssef

29. Courtesy of Dr. Ahmed A. Youssef

30. Courtesy of Dr. Ahmed A. Youssef

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