Body Language

The Angel lift

Tailoring skin rejuvenation treatments to individual patients can improve clinical outcomes and patient satisfaction. Mr Kambiz Golchin describes the application of the Angel Lift, a therapy combining fractional CO2 laser with autologous fat grafting and concentrated platelet rich plasma

This decade has seen an explosion in the number of non-surgical aesthetic procedures carried out in the UK and worldwide. The main driving force behind this is the ever increasing demand by patients for less invasive procedures with less down time. However less invasive treatments have traditionally been associated with less dramatic results.

As clinicians, we have an ever expanding array of aesthetic treatments at our fingertips with exciting emergent combination therapies—both surgical and non-surgical techniques that are expanding both patient and clinician choice. These emerging treatment modalities incorporate a wide range of autologous biotherapies and innovative technologies that provide a spectrum of treatments that can be designed to the exact requirements of the patient. This is individualised health and aesthetic choice at its elegant best.

The convergence of new biotherapies and established technologies are providing a raft of new therapies that are rapidly becoming mainstream in skin rejuvenation, tissue reconstruction and tissue regeneration. For example the application of autologous concentrated platelet rich plasma (cPRP) and autologous fat grafts (AFG) have generated a great deal of excitement amongst the clinicians. However, the key to the successful integration of these technologies is science and the clinical techniques to optimise individual patient treatment and clinical outcomes.

Components

The Angel Lift is a treatment using this aesthetic ‘alchemy’ concept, combining the use of autologous biotherapies with laser technologies. The critical component of this combination of therapies is clinical technique and a good understanding of the scientific principles. There are three treatment options for the Angel Lift:

1. Angel PRP, using cPRP which can be used on its own or in conjunction with other non-surgical aesthetic procedure such as dermal fillers.
2. Angel Lift, combining fractional laser technology and concentrated platelet rich plasma. This is ideal for patients with the need for comprehensive skin rejuvenation including wrinkles, photodamage and loss of collagen.
3. Angel Lift Plus, incorporating autologous fat grafts with Angel Lift, specifically for older patients with volume loss, poor skin elasticity and photodamaged skin.

Defining which of the treatment components—autologous fat, platelet concentration or laser resurfacing—are more effective, remains difficult to quantify. There is good experience to date with each individual treatment but the sum of the parts has a greater impact as there is a synergistic effect. Results obtained are more than encouraging, with a natural approach to turning back the years using patients’ own stem cells and growth factors to aid the healing process and improve results.

In determining whether or not to provide this treatment, it is important to remember that the primary indicator of ageing is the appearance of skin. A major component of aged skin is the fragmentation of the dermal collagen matrix. This results from enzymes such as metalloproteinase impairing the structural integrity of the skin. Fibroblasts that produce collagen cannot attach to fragmented collagen. This inability to attach causes loss of support and the fibroblasts collapse, producing low levels of collagen and high levels of collagen degradation enzymes. This creates a never-ending cycle which contributes to ageing skin.

Dissecting out the constituent components of the Angel Lift concept provides the scientific and clinical rationale behind the choice of the technologies and the autologous biotherapies involved in the procedures, specifically:

• Fractionated CO2 laser resurfacing
• Concentrated platelet rich plasma therapy
• Autologous fat grafting (AFG)

The fractionated CO2 laser is the gold standard approach to resurfacing the skin. The laser is used to ablate and resurface the epidermis, with the aim of improving overall skin tone, texture and appearance whilst simultaneously stimulating collagen formation at the level of the reticular dermis.

Research

Described by Marx et al., platelets contain seven fundamental groups of protein growth factors, which are released to initiate wound healing. These include: three isomers of platelet derived growth factors (PDGFαα, PDGFαβ, PDGFββ); transforming growth factor (TGFβ1 and TGFβ2); vascular endothelial growth factors (VEGF); transforming growth factors; and insulin-like growth factors (IGF).
Work by Zuk et al. in the early 2000s provided us with insights into the potential of the adipose derived adult mesenchymal stem cells (AD-MSC), the importance of the progenitor cells within the stromal vascular fraction (SVF) in conjunction with the extracellular matrix (ECM) and their overall synergistic effect on the viability of the autologous fat grafts. This opened the way to new areas of reconstructive surgery as well as clinical regenerative therapies.

The latest research suggests that the role of progenitor cells is even more important than previously acknowledged and that the long- term survival of AFG is directly linked to the activation and proliferation of these progenitor cells within the SVF to differentiate into the target cells for replacement.

This intricate biological ballet occurs within a “cellular microenvironment of cell-to-cell/cell to matrix, and autocrine/paracrine signaling,” and concentrated platelet rich plasma—rich in chemokines, cytokines and growth factors—is considered to optimise the cellular microenvironment.

Autologous fat grafts are at the vanguard of these clinical applications, particularly as adipose tissue is relatively easily and safely accessible. They simultaneously provide a rich source of heterogenous stromal stem cells capable of forming a ‘bioactive scaffold’ for various non-surgical and surgical aesthetic and reconstructive procedures as well as providing a volumising and filling effect.

As our knowledge and understanding of the use of fat grafts has expanded, new techniques have emerged in the harvesting of fat, based largely upon our increased understanding of the cellular activity and homeostatic environment required for the maintenance of the integrity of the harvested fat and therefore the viability of the fat graft.

Using concentrated PRP in combination with the progenitor SVF-enriched fluid improves the viability of the fat graft and survival rates are therefore improved, as described by Gentile et al. in their study on fat grafting in breast reconstruction.

The Angel Lift procedures are scientifically-based and technique-dependent, incorporating laser technologies and autologous biotherapies into a combination treatment package designed to improve clinical outcomes and provide clinicians and patients with a range of treatment options.

Mr Kambiz Golchin is a consultant ENT facial plastic surgeon, who practises at the Beacon Face and Dermatology clinic in Dublin, Ireland. E: dr@bfd.ie W: beaconfaceanddermatology.ie


References

1. Marx, R.E. “Platelet Rich Plasma: Evidence to support its use.” Journal of Oral Maxillofacial Surgery 2004, 62:489-496.

2. Zuk, P.,A., Zhu, M., Ashjian, P. et al. “Human Adipose tissue is a source of multi-potent stem cells.” MolBiol Cell 2002;13(12):4279-4295.

3. Strem, B.M., Hicok, H.C., Zhu, M. “Multipotential differentiation of adipose-derived stem cells.” Keio Journal of Medicine. 2005;54(3):132-141

4. Alexander, R.W. “Use of PRP in Autologous Fat Grafting.” Springer, Berlin 2010

5. Alexander, R.W., Harrell, D.B. “Autologous fat grafting: use of closed syringe microcannula system for enhanced autologous structural grafting.” Clinical, Cosmetic and Investigational Dermatology 2013:6 91-102.

6. Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Curcio CB, Floris , M ,Fiaschetti V, Floris R, Cervell V. “A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction.” Stem Cells Transl Med. 2012 Apr;1(4):341-51. doi: 10.5966/sctm.2011-0065. Epub 2012 Apr 13.