Injecting platelet-rich fibrin matrix (PRFM) to restore facial volume and fill lines can be a patient-pleaser, but surgeons need to select the right patients and the right facial areas to treat, according to facial plastic surgeon Anthony P. Sclafani, M.D., who co-authored a study on PRFM in May/April 2012. The study, called “Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix,” published in the Archives of Facial Plastic Surgery remains the most-read article on the Journal’s RSS feed today.
Dr. Sclafani, director of facial plastic surgery and professor of otolaryngology at Weill Cornell Medicine and New York Presbyterian, tells Cosmetic Surgery Times that surgeons’ interest is probably high because patients are enthralled with the concept of what they’ve come to know as PRP. Surgeons, however, are just starting to embrace the facial augmentation approach because, until recent years, the literature has been inconsistent and spotty.
The body of evidence in support of PRFM is growing, he says. But there remain some misconceptions even among cosmetic surgeons, according to Dr. Sclafani.
PRFM is different than what surgeons consider standard, or pure, PRP.
“With PRP, there is a very high concentration of platelets in a very small volume, and the platelets are induced to release the growth factors immediately. PRFM is somewhat enriched. It’s a much higher volume. It includes the plasma and incorporates fibrin,” Dr. Sclafani says.
The concept is this: The injected platelets from PRFM induce some sort of reparative function, releasing growth factors. This starts a wound healing cascade, which, basically, stimulates collagen production.
Fat and Collagen Production
Dr. Sclafani says he has been using PRFM for about eight years and has seen positive effects. The study provided a scientific and physiologic foundation to what he had been seeing clinically. And since, he has refined his patient selection process and better determined where PRFM works and where it doesn’t on the face.
The study involved injecting PRFM (The Selphyl System, Aesthetic Factors Inc.) into the forearms of four adult volunteers. The point of the study was to look qualitatively at changes in the skin and sub-dermis from PRFM.
“We injected into the dermis; we injected below the dermis; then, did serial biopsies over a course of time,” he says. “What we saw was new collagen being produced in about a week. By 2 to 2.5 weeks, there was a significant amount of collagen being produced. At by about 2.5 weeks, we started to notice fat cells, where there normally wouldn’t be fat cells in the area where we injected.”
The collagen produced post-injection turned into mature collagen by about week 10, according to Dr. Sclafani.
The researchers noted localized fat cell production, which wasn’t aggressive within the dermis but was more pronounced below the dermis, where fat cells are more likely to exist.
Patient, Physician Expectations
PRFM is not a filler or media like Restylane or Juvéderm, he says. It doesn’t produce a tremendous amount of volume like a filler.
“I discuss this at length with patients,” he says. “This is not something where they see an immediate result. If they want to see an immediate result, PRFM is not for them. It’s not for the patient who has a really significant volume need. It would just take too many treatments and too long to really give them that correction.”
PRFM for the face, Dr. Sclafani says, works best to correct the hollows under the eyes.
“I think it blends very well. It’s not going to produce a lumpy correction,” Dr. Sclafani says. “That’s an area that I find patients are willing to incrementally improve over the course of two or three treatments.”
He also uses it to slightly augment the cheeks and to fill nasolabial folds.
“I don’t use it at all in the lips. I’ve been very disappointed with it in the lips,” he says. “I use it cautiously in the nose for secondary rhinoplasty.”
Results often last a year or more. And when patients return for touchups, they generally still look improved compared to how they looked in photos taken prior to treatment, according to Dr. Sclafani.
Surgeons who decide to offer PRFM should brace for the time spent educating patients that while fillers offer an immediate result after one treatment, results from PRFM take time and multiple treatments are usually required. That wait is even challenging for Dr. Sclafani, who says PRFM tends to be less gratifying than procedures that offer more immediate results.
Nevertheless, Dr. Sclafani says the option is important for patients because PRFM is their own tissue and it induces a natural healing process for a sustained effect.
Disclosure: Dr. Sclafani’s study was supported by Aesthetic Factors Inc. and he is a former consultant for the company.
Sclafani AP, McCormick SA. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch Facial Plast Surg. 2012 Mar-Apr;14(2):132-6.