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Dr. Samuel Lam is a double board-certified facial plastic surgeon and a board-certified hair restoration surgeon. He is the owner of the Willow Bend Wellness Center and has authored five major medical textbooks, over 150 book chapters and scientific papers as well as lecturing nationally and internationally with over 200 lectures to date. Dr. Lam has won numerous awards, including the 2002 John Orlando Roe Research Prize for his research on skin rejuvenation, and is a fellow of the American College of Surgeons and the American Academy of Facial Plastic & Reconstructive Surgery. For more information, visit his website at http://www.lamfacialplastics.
FutureDerm: The Vampire Facelift™ gets its name because plasma from the patient’s own blood goes into their face. How exactly does that work?
So basically the key thing is platelet rich plasma (PRP). Now to get platelet rich plasma you take the blood out and it undergoes a centrifugation process and there’s many different ways of purifying the blood. And what you’re trying to do is you’re trying to take the red blood cells and the white blood cells out, so that you leave behind the plasma, which is the liquid part of the blood, with growth factors, that’s what distinguishes it from serum, along with platelets. And the reasons platelets are great is that platelets hold the growth factors in them and they’re released via different mechanisms.
You take the PRP and the ideal going more technical is that the platelet count should be 1.7 to 2.5 X physiologic levels in a concentrated zone. Studies have shown in recent wound healing that platelet counts that are too high, like on the order of 4 or 5 X sometimes 15 X actually can diminish the viability of the entire PRP context. It so happenxs to sort of overload deactivation. So you want to be careful of the degree of platelets in there. And I’ve used multiple systems for PRP and I’ve also used PRP for multiple different scenarios.
I think 2013 is the year of PRP; it’s really where things are going. Obviously the term Vampire Facelift™ comes from the idea that you’re drawing your own blood and re-injecting it. It’s a marketing term more than anything else and it’s branded and bought by the Regence Company and I use the Regence company products for part of the my work and other types of PRP for other things.
FD: Is there any time the blood you remove won’t work?
The PRP is first drawn and the key is that you don’t want any external trauma to the skin before the PRP is harvested and the reason for this is that if you undergo a laser or some Botox™ or some fillers before you draw the blood, your body is starting to undergo the repair process and it draws all your blood to the site of injury. Now what you want is for all your growth factors to be clean and abundant as you pull. So you want to definitely draw the PRP first off before you do anything to the skin.
FD: The PRP has to be activated to work. Can you tell me the ways to do that?
With a patient you want to rejuvenate the skin, so what you’re doing at this point, to get PRP activated in the skin, there are multiple ways to do it. One is that you can use an activating product. Types of activating products are bovine thrombin, in other words cow thrombin; another type of product you can use is calcium gluconate and that can also stimulate the PRP to be activated. The other method is you can use calcium chloride and these you either swirl in with your PRP or inject after the fact.
If you swirl it with the PRPR, the negative that I don’t like is that it makes things thick within about three minutes, so you’ve got to inject it pretty fast, otherwise it starts to activate. Some people don’t believe that activation is critical because you can activate by means of other trauma. So how do you activate PRP in the traumatic way? That would be one of two mechanisms. You use either laser technology or a roller, like a derma pen or a derma roller.
A derma roller you can essentially get on Amazon for $10, it looks like you roll paint, but instead their al these micro needles between .5 millimeters to 2 millimeters in length, I try to use 1 millimeter. So what you’re doing is you’re rolling it on the skin and creating these holes in the skin. It’s used for skin rejuvenation in the absence of other therapies and you roll it on the skin.
The derma pen is a little bit fancier mechanism; to me it’s about the same thing. It’s like a little pen and you stick on disposable array of needles in the based and turn it on and like a jackhammer in and out it goes into the skin. Which one is better? I have both and I think they’re both the skin. And the theory behind it, again this is a bit voodoo-y, to be honest with you, I’ve spoken with a lot of different people about what their protocols are.
Some people believe that if you’re going to laser the patient to activate the PRP, you should do it right before the PRP is placed because it can denature the PRP if you put the laser on second. I don’t really believe that, I think the laser does fine. Some people believe you don’t even need a laser, you can just activate it with the trauma itself, and you’ll be fine.
Typically I do a little bit of “belt and suspenders,” I’ll pass the laser over it, I’ll inject the PRP into the skin using the cannula technique over the area that’s the subcutaneous plane and then I’ll come back and I needle it. After I needle it there’s a little bit of bleeding. I use a product on top of that right afterwards called Oxygenetix, it’s a makeup product but it also helps to heal the skin because you’re a little red everywhere. Within a day or two you’re pretty much healed, so you’re pretty much healed at that point, pretty fast, unless you have major bruising.
FD: How much blood is used? And what goes in besides PRP?
I pull about 20 CC’s for a Vampire Facelift™. The other problem with the PRP is that you don’t want to put a bucket of it into the face because there is some evidence that it adds some volume changes to the face at well. Vampire Facelift™ is also predicated on the use of a hyaluronic acid like Restylane or Juvéderm injected first into the scaffold to add volume to the face. So, to say that PRP adds truly measureable volume to the face is difficult to assess. That’s why people have used hyaluronic acid in combination. That’s truly what a Vampire Facelift™ is, it actually adds hyaluronic acid. I don’t like to use tons of PRP volume because of the risk of too much volume in the face, so just enough to cover the face.
FD: Who is an ideal candidate?
I would say someone maybe early 40s late 30s, someone with mild to moderate sun damage and realistic expectations. Someone that has significant damage to the skin, they’re going to get something more ablative, in other words, knock out the whole skin. And I would still use the PRP with it, it just won’t be considered a Vampire Facelift™ because you’re not doing HA’s, you’re not doing a light treatment with an IPL or light activation. But I will tell you that almost everyone is a candidate for having PRP added to a treatment, but not everyone is, by the narrow definition, a candidate for the Vampire Facelift™.
FD: Is there anyone who isn’t an ideal candidate?
You mean, like a contraindication where it would be not safe to have their own blood re-injected in their face? I can’t think of anyone because it’s just your own blood filtered and re-injected back in. It’s not like you’re having an allergic reaction to it. If you’re using bovine flombin as an activating agent, you have to know that you can have an allergy to bovine flombin. There’s very few people who use bovine flombin, I’ve used it, some of the kits I’ve had in the past have used it.
Generally speaking I don’t see a major contraindication or a reason not to use PRP.
FD: What are the results of PRP and when do you see them?
You start to see some changes within about two months afterwards. There not major changes but they’re sort of like a facial on steroids or like a mini laser, if you will. You’re going to see more textural changes. And typically you’re’ needing ideally multiple treatments on the order of every three months or so, like you’re getting Botox or other therapies to get your skin up, to speed to get it a little better.
So that’s how PRP works in the setting of the Vampire Facelift™. Do I think it’s gimmicky? No, I think it works. I really think PRP is great.
You know, right now I would say it’s unclear whether there are comparable technologies.