Joris van Dongen

213 PRP enriched facial lipofilling DISCUSSION This randomized placebo controlled double blinded study was undertaken to investigate the possible beneficiary effects of adding PRP to aesthetic facial lipofilling in a well-defined healthy patient cohort. The results clearly demonstrate that the addition of PRP to the lipograft significantly reduces patient’s reported recovery time. However, the addition of PRP to the lipograft does not significantly improve skin elasticity, changing in nasolalial fold depth nor overall patient satisfaction as compared to lipofilling alone. The reversal in the correlation of net elasticity as a function of patient age could suggests some form of rejuvenation by lipofilling that is enhanced by PRP, but lacked significance with the number of patients in this study. Reported in vitro effects of PRP 10, 22-24 thus could not be reproduced in our clinical study setting, possibly by incontrollable patient related confounding factors combined with a small therapeutic window for effect. Moreover, reported effects of ‘normal’ (not SVF/ ASC enriched) lipofilling on skin rejuvenation, as has been reported and suggested to be seen in clinical studies when used in combination with facelift surgery 2, 9 could also not be addressed and forces us to question what the additional effect (next to some volume enhancement) of normal lipofilling is when used during facelift surgery. Lipofilling does not increase skin elasticity in the aging face, even with added PRP. Since the comeback of lipofilling, suggestions were made that it is ‘more than a filler’ 2 and may induce rejuvenation of the skin. However, this ASC induced effect, is only well studied after deep dermal injury (e.g. thermal- radiation damage, excessive scarring 4, 25-27 ). Surprisingly skin rejuvenation of the normal aging skin has only be described, and studied histologically by Rigotti et al. 9 In this study, an increase in dermal elastin deposition was reported in biopsies after normal lipofilling of the aging skin. However, to this date, no controlled studies were done to verify the clinical relevancy of their finding. In our study, skin elasticity was determined with the Cutometer since it is a reliable and validated method of measuring skin age, and the mostly likely candidate to show changes, supported by the findings of Rigotti et al. Nevertheless, there remains minor controversy regarding the reliability of the Cutometer. A study of Nedelec et al. presented low intraclass correlation coefficients of skin elasticity measurements of dermal scars. The intraclass correlation coefficients found for normal skin elasticity measurements were, however, acceptable for the R0 (0.81), R6 (0.81) and R7 (0.78) parameter 28 . We found that normal (not SVF/ASC boosted) lipofilling with or without PRP did not alter skin elasticity. Reversal of the correlation between age and elasticity however, might suggest a small effect size, thus not significant with our small study