Growth Factors in Plastic Surgery

Aging is a complex process that brings molecular changes, which show at a cellular level, as well as at an anatomical one. Skin aging is the most notorious change.

GF regulate skin remodelling, so thy have a very important role in the way skin looks. Age decreases their production .

Fig. 215-11. Combined usage of CO2 laser and GF.

In aesthetics, their use cooperates with re-epithelization. GF also improve the result of any kind of peel process. Thy have been applied by messotherapy (wrinkles, elastosis), subdermal injection (scar digressions, fibrosis), mixed with fat (fat grafting) and on scars to cooperate with the healing process.

Another interesting application in aesthetics is the use of PRP (platelet-rich plasma) in modelling and enlarging processes (especially on the face) .

Facial rejuvenation:

The subcutaneous application of GF-Containing plasma to specific facial areas reorganises collagen fibres bringing elasticity back to skin. Besides, the injury caused by the needle triggers inflammatory events that will complement the effect caused by the GF that were applied to tighten the skin.

Fig. 215-12. A.  face surgery and blepharoplasty, CO2 laser and GF. Before and after 12 months. B) Facial middle third Surgery. CO2 and GF. Before and 10 months later.

Fig. 215-13. Intradermic GF combined with CO2 laser for perioral wrinkles treatment.

Fig. 215-14. Around the orbital zone.

Fig. 215-15.  Intradermic GF combined with non-invasive laser (intense pulsated light) and botulinium toxin.

Solutions with a very poor GF concentration are injected in facial surgeries on the detachment lifting areas. By doing this we cooperate with the attachment of the flap. Sutures are also injected with these solutions to improve cicatrisation, vascularization and overall skin image. Recovery is much simpler with less hematomas. Their use has also been associated to a decrease of post-surgery times and in the incidence of the complications.

In blepharoplasty GF are also used in sutures obtaining great results. They are sometimes the reason why stitches are removed earlier. An earlier stitch removal leads to less visible scars. (Fig 215-10)

In facial, neck and neckline rejuvenation, GF are used as a complementary technique to intense pulsated light treatment. These way results of both treatments are enhanced .

Fig. 215 - 16  GF application during hair micro-implants.



Fig 215 - 17.



Fig 215 - 18.

They can also be used combined with skin resurfacing done with CO2 laser. The solution with a high GF concentration is applied subcutaneously. An intense post-laser-application treatment is later done on skin.

By destroying capillaries, laser application itself causes the release of GF. Phototermolisis originated by laser, releases GF that are going to stimulate apoptosis, mitosis and cicatrisation. This effect is enlarged by the extra GF applied during treatment. (Fig 215-12)

Other techniques can be applied as well, such as Botulinum toxin to treat perioral and periorbital wrinkles. (Fig 215-13 to 215-15)

Hair loss adjusts to different therapies. If it is temporary, clinical treatment is applied. If it is permanent hair implants can be the solution. There are many different techniques to perform this treatment.

In diffuse alopecia, a high concentration of GF in infiltrated subcutaneously to the scalp. This improves and stimulates hair growth by interfering with the initiation and the duration of the anagena phase.

With more than 40 years working in scalp surgery to treat hair loss, we are aware of the importance of associating different surgical procedures: hair by hair application, mini-micro-grafting, flap, expansions and reductions. These surgeries are combined with intrasurgical GF injections to strengthen the hair, reducing its loss and improving recovery. GF stimulate angiogenesis related to the growing process of the hair follicle (Fig 215-16)

Using calcium and thrombin, we coagulate high-GF-concentrated plasma to obtain autologous fibrin. We use this fibrin to keep hair micro implants constantly surrounded by GF. This is important because implant need to be kept in a proper environment while the surgery takes place. This also cooperates to achieve better results and improves the implant’s engraftment .

Stem Cells

Definition
Stem cells are those that are able to self renovate independently if stimulated by the correct signs. This means that they are able to generate mature cells with morphological and functional specific characteristics.

Terms used to name these cells depend on their behaviour in vitro and in vivo.

A pluripotent stem cell is able to produce mesodermic, ectodermic and endodermic cells. These cells generate the three embryological layers (Fig 215-19)

A unipotent stem cell is only found in grownups and produces just one type of cells. If this cell receives the proper signal it will reproduce itself constantly.

It takes many different types of cells to repair harmed tissues. This is when pluripotent cells are activated .

Fig. 215 - 19.

Mientras que una célula madre unipotente se encuentra en el adulto y da origen a un solo tipo celular, es capaz de autorreplicarse durante toda la vida dependiente del estímulo. Sin embargo, cuando existe daño tisular se necesitan diferentes tipos celulares para la reparación del tejido, y es entonces cuando se activan células madre pluripotenciales.

Cellular Classification
With technological and scientific advances, three different types of stem cells were identified:

1. Embryonic
2. Germ
3. Adults

1. Embrionic Stem Cells are originated from blastocyst´s internal layer before the uterine implantation. They are pluripotent cells. Experimentally, they come from embryos that were created in vitro and donated for investigation under donor contentment.

2. Germ Cells come from embryo’s germ follicles (that are going to generate adult’s gonads).

3. Adult’s Stem Cells are undifferentiated but located among differentiated cells in an organ or tissue. They are able to self renovate. This means that they are able t create identical copies of themselves for extended periods of time. Under physiological or pathological conditions, these cells can produce many different types of cells with specific functional and morphological characteristics. This capacity is known as multipotent. Typically these cells, before finishing the differentiation process, go though an intermediate stage. This stage is known as progenitor or precedent cell.

Adults Stem Cells