Platelet-Rich Plasma with Basic Fibroblast Growth Factor for Treatment of Wrinkles and Depressed Areas of the Skin.

Platelet-Rich Plasma with Basic Fibroblast Growth Factor for Treatment of Wrinkles and Depressed Areas of the Skin Sir: W have read with plenty of interest the original article by Kamakura et al. entitled “Platelet-Rich Plasma with Basic Fibroblast Growth Factor for Treatment of Wrinkles and Depressed Areas of the Skin.”1 The authors’ reputation regarding platelet-rich plasma with basic fibroblast growth factor to treat wrinkles and depressed areas of the skin is indisputable. However, we have some concerns regarding the methodology of the study. First, the authors did not specify the platelet count in their platelet-rich plasma. As for any drug, it is critical to know the exact concentration of the active substance studied. Second, the authors did not specify whether the platelet-rich plasma was activated or not. If activated platelet-rich plasma was used in this study, what was the activator? When platelets are activated by thrombin, their morphology changes irreversibly, and more than 95 percent of preserved growth factors are released within 1 hour.2 Very likely, such an important concentration of short-lived growth factors has nothing to do with a gradual release. In a recent study, nonactivated platelets were reported to more efficiently enhance adipose-derived mesenchymal stem cell proliferation than activated platelets.3 However, the addition of calcium chloride alone leads to a slow release of growth factors over 7 days. This method is the most used in clinical application.4 Third, they harvested the buffy coat. Thus, it can be assumed that the platelet-rich plasma had a high concentration of leukocytes. However, the concentration of leukocytes and the leukocyte-to-platelet ratio in this platelet-rich plasma was not specified in the article, whereas it is known that the concentration of leukocytes may affect the results. Fourth, the authors described centrifugal force in revolutions per minute and not in newtons (or the acceleration in gravity), and it is well known that a given revolutions-per-minute value can result in different forces according to the rotation radius. Fifth, we think that testing a new process in aesthetic medicine in humans requires approval by an ethics committee. Incredibly, the authors started the procedure on humans in 2008 but they published their results on animals in 2012. Sixth, we are not sure that the study was retrospective because changes in the Wrinkle Severity Rating Scale grade were examined before and after treatment. Please specify. We fully share the authors’ opinion regarding the fact that excellent aesthetic results may be obtained with platelet-rich plasma. However, in our opinion, the methodology as a whole does not support the main conclusion. We would greatly appreciate cooperating with this team for future studies in that field. DOI: 10.1097/PRS.0000000000002195