RU2629527C1 - Method for correcting age-related changes in face and/or body soft tissues - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for correction, a course of three procedures is performed, including the introduction of thrombocytic autoplasm (TAP) into tissues. Before each procedure, sampling of blood in a volume of 9-36 ml is performed, which is centrifuged to obtain a native form of TAP. In carrying out the first two procedures 4 ml of the obtained native TAP form are taken into 4 sterile syringes by 1 ml in each syringe and placed in a thermostat at a temperature of 56°C and exposure for 5 minutes to obtain a fibrin form of TAP. The fibrin TAP form is mixed with 4 ml of native TAP form through the connector, connecting each syringe with the fibrin TAP form to the syringe with the native TAP form and making 5-10 passes from one syringe to the other. The resulting mixture is introduced into the upper layer of the dermis with a needle with a diametre of 30G and a size of 0.3×12 mm or with a cannula with a diametre of 2×5G and a length of 50 mm by papular, tubercular, linear-retrograde, fanning or bolus techniques of mesotherapy. When carrying out the third procedure 4 ml of the native TAP form is taken into 4 sterile syringes by 1 ml in each syringe and placed in a thermostat at a temperature of 75-80°C and exposure for 10 minutes to obtain a protein form of TAP. After cooling for 2 minutes, syringes with the protein TAP form are connected by a connector with an empty syringe and 10-15 passes are made from the syringe with a protein form into each empty syringe and back. The mixture is introduced into the deep layers of the dermis, the hypodermis and the periosteum by means of a cannula with a diametre of 22G and a length of 57 mm by linear-retrograde, fanning or bolus technique. If necessary, the course is repeated 2 weeks after.

EFFECT: increased efficiency.

4 cl, 2 ex

Description

The invention relates to medicine, in particular to cosmetology and dermatology, plastic and reconstructive surgery and aesthetic medicine, and can be used to eliminate volumetric changes in soft tissues, congenital and acquired deficiency of soft tissues, to correct age-related changes in soft tissues of the face and body, consequences injuries.

One of the main tasks of modern cosmetology today is the task of effectively correcting age-related changes in the face and body. At the present stage of the development of aesthetic medicine, facial aging means not only age-related changes in the skin, but also changes that occur in the muscles, ligaments, fatty tissue and bone structures of the facial skull.

Currently, the main requirements for cosmetic procedures are: efficiency, safety and a comprehensive individual approach to solving aesthetic problems. All modern methods of combating age-related skin changes are aimed at improving its regenerative capabilities. At the same time, it is absolutely clear that to achieve optimal aesthetic results, work is needed in different layers of the skin, as well as improving trophism of muscles, subcutaneous tissue, and prevention of age-related changes in bone structures.

The closest analogue is the method proposed by Akhmerov P.P. and Korotkova O.I. (RF patent 2582948). The known method involves the collection of venous blood in a volume of 9-36 ml, then the blood is centrifuged with an acceleration of 1000G for 5 minutes, then 3.0 ml of the obtained TAP are taken from the tube with syringes with a luer-lock system. TAP syringes are placed in a thermostat and kept to obtain a gel. For introduction into the periorbital zone and in the neck, TAPs are kept at a temperature of 45 ° С for 5 minutes, and for introduction into other zones of the face, TAPs are kept at a temperature of 85 ° С for 6 minutes. The resulting gel is cooled in a sterile tray for 2 minutes. Then, using the connector, the syringe with the obtained gel is connected to an empty sterile syringe and 5-10 passages from one syringe to another are carried out and injected into the soft tissues of the face, except for the periorbital zone, using a 21G × 3.8 cm needle with a short cut. Before introduction into the periorbital zone and / or neck zone, the obtained TAP gel is mixed with thermally untreated platelet-rich autologous plasma obtained from the same patient in a 2: 1 ratio and introduced into the tissue of the periorbital zone and / or neck area using a 27G × 13 needle mm with a short cut.

One of the disadvantages of the known method is the trauma due to the use of a 21G × 40 mm needle. At the same time, the use of a large diameter of the needle is associated with a significant density of the material obtained, which leads to the appearance of frequent hematomas and complicates the use of this technology in areas with thin skin (in the periorbital, perioral, and neck areas). In addition, the use of material obtained at a temperature of 45 degrees, at which there is no irreversible denaturation of any of the fractions of blood proteins, has no biochemical and pathogenetic justification. The reason for choosing this temperature is not explained. This circumstance does not allow us to adequately predict the changes in tissues expected after the introduction of this material. In our developed method, we offer a fibrin form that is fundamentally new from a biochemical and pathogenetic point of view.

The fibrin form we receive allows us to condense tissues due to the loss of fibrin filaments at a temperature of 56 degrees and the formation of a fibrin biomatrix, around which new collagen fibers are further synthesized.

Our proposed protein form is close to that obtained at 85 degrees, the form described in the invention of Akhmerov P.P. and Korotkova O.I., but allows the use of less traumatic 27G needles of 0.4 × 13 mm and / or 25G and 22G cannulas when introduced. All this makes the procedure technically easier for the doctor and less traumatic for the patient, resulting in a reduced rehabilitation period and the number of possible complications and adverse reactions in the form of hematomas. The lower density of the drug obtained by heating to 75-80 degrees, allows them to work in areas with thin skin, such as the perioral and periorbital regions and the neck area.

The technology includes the collection of venous blood in a volume of 9-36 ml, then its single centrifugation with a centrifugal force of 1000G for 5 minutes. The obtained TAP is taken from the test tube with sterile syringes with a luer-lock in the amount of 3-5 ml (the volume of the obtained TAP depends on the patient's blood hematocrit, i.e., on the ratio of the number of cells to the liquid part of the blood). Platelet autoplasma has a number of effects: it is stimulation of tissue regeneration, activation of metabolic processes in them, increase of local tissue immunity, and improvement of microcirculation. All these effects are provided by the action of platelet growth factors, which are contained in their alpha granules, and enter the tissues after degranulation.

TAP syringes are placed in a thermostat and kept until thermally processed modifications are obtained.

To obtain a fibrin form, TAP is kept in a thermostat at a temperature of 56 degrees for 5 minutes. This technology is based on the fact that a specific feature of fibrinogen is light denaturation by heating at lower temperatures than globulins and albumin. For irreversible denaturation of fibrinogen, a temperature of 52-56 degrees and above is sufficient. The phenomenon of denaturation of fibrinogen is very similar to the natural phenomenon of coagulation, while fibrinogen - carpuscular protein passes into fibrin - fibrillar protein. A rare lattice forms, the so-called fibrin matrix (P. G. Grigoriev, “Technology of protein plastic masses” Moscow 1935; Scopes R. “Methods for protein purification”: Translated from English - Moscow: Mir, 1985.).

The fibrin matrix promotes normal cell infiltration of monocytes, fibroblasts and other cells that play an important role in wound healing. The method of using the fibrin form of TAP consists in injecting platelet autoplasm heated in a thermostat to 56 degrees C into the skin of the face and body, resulting in irreversible denaturation of fibrin and reversible denaturation of other plasma proteins (P. G. Grigoryev, “Technology of Protein Plastic Masses” Moscow 1935 ; Scopes R. "Methods of protein purification": Transl. From English. - Moscow: Mir, 1985.). Fibrin filaments, when injected into tissues, are a kind of natural mesh matrix around which new collagen fibers are synthesized and tissue is densified. The resulting preparation is cooled in a sterile tray for 2 minutes and injected into the soft tissues of the face and body with a 30G needle of 0.3 × 12 mm papular, tubercle, or linear retrograde mesotherapy techniques, which is a less traumatic technique than the introduction of a 27G × 13 needle. proposed in the methodology of Akhmerov PP and Korotkova OI, as well as biochemically and pathogenetically more justified due to the work in the tissues of the fibrin matrix. Since platelet growth factors become inactive after heating of the autoplasm, this form is often used in conjunction with the native form of TAP, which makes it possible to use both mechanisms related to growth factors and the prolapse of fibrin filaments. For this, the fibrin form is mixed before administration, connecting the syringe with the native form of TAP and with the fibrin form of the TAP of the same patient using a connector and performing 5-10 passages from one syringe to another, in a 1: 1 ratio.

The method of using the protein form of TAP is the technology of administering a drug obtained from the patient’s own native TAP by heating it to a temperature of 75-80 degrees C in a thermostat in 2 ml sterile syringes with a luer-lock for 10 minutes. In this case, irreversible denaturation of all plasma proteins is observed. For albumin, the temperature of irreversible denaturation starts from 67-72 degrees, for globulins from 69-75 degrees. When heated, the plasma begins to cloud with 64 degrees, which provides visual control of protein denaturation (P. G. Grigoriev, “Technology of protein plastic masses” Moscow 1935; Scopes R. “Protein purification methods”: Translated from English - Moscow: Mir, 1985.). The resulting gel was cooled in a sterile tray for 2 minutes, then homogenized by mixing. To do this, a syringe with a protein form of TAP is connected using a connector with an empty syringe and 10-15 passes are made from one syringe to another, which makes the drug more controlled during administration and allows the use of 27G needles of 0.4 × 13 mm and / or 25G × cannula 50 mm and 22G × 57 mm, which makes the tissue volumization procedure less traumatic, in contrast to the technique proposed by Akhmerov PP and Korotkova OI, where 21G × 38 mm needles are used, since the preparation obtained by heat treatment at 85 degrees is denser, which does not allow the introduction of thinner needles and complicates its introduction through cannulas. Therefore, the technology we have proposed is technically simpler for the doctor and less traumatic for the patient.

Denatured protein, when ingested, is cleaved by protease enzymes to amino acids, which compensate for the deficiency of structural material in tissues and are used in synthetic cell processes. As a result, structural improvement of tissues occurs. Thus, the use of protein modification of TAP performs not only the role of tissue filler, but also makes up for their structural deficit. The rate of biodegradation of thermally treated autoplasma will depend on the activity of tissue protease enzymes, as well as on the level of amino acid deficiency in tissues.

To administer the drug from heat-treated platelet autologous plasma, we use the following administration techniques:

- linear

We use this technique in the correction of longitudinal wrinkles of the forehead, pre-cerebellar, chin, and lip areas.

To correct longitudinal wrinkles of the forehead, the needle is inserted 0.5 cm lateral to the start of the wrinkle, soft tissue is separated, the drug is administered retrograde, the volume of administration is 0.2-0.3 ml of the drug per wrinkle. Perhaps the introduction of the drug using a cannula. This amount of the drug allows you to achieve a natural looking forehead, without longitudinal folds. After the introduction, dense kneading of the drug in the tissues. This technique allows you to "raise" the volumetric defect, to achieve uniform distribution of the drug.

For correction of the pre-colic zone, the needle is inserted 0.3 cm distal to the beginning of the fold, soft tissue separation is mandatory, the drug is administered retrograde, the volume of administration is 0.4-0.6 ml, this volume will allow to raise and smooth the precoccal zone. Perhaps the introduction of the drug using a cannula.

To correct the chin area, the needle is injected 1 cm proximal to the beginning of the wrinkle, soft tissue is separated, the drug is injected retrograde in the direction of the wrinkle, 0.3-0.5 ml of the drug for each wrinkle, this volume is enough to model the lines of the oval without undue weighting . After the drug is injected into each wrinkle, kneading is performed - “modeling” of the chin area and face contour using uniform pressure to distribute the drug. Perhaps the introduction of the drug using a cannula.

In the area of the lips, the needle is injected 0.3 cm lateral to the corner of the mouth, the direction of the needle is parallel to the circular muscle of the mouth in the direction of the middle of the lips, the drug is administered retrograde, for each quadrant 0.2-0.25 ml of the drug. After the introduction of the drug, softly kneading the tissues of the lips, placing the lips between the index and thumb. This technique allows you to achieve minimal trauma in the lips, a natural look for the patient and adequate correction. Perhaps the introduction of the drug using a cannula.

- fan

We actively use this technique to correct the bridge of the nose (glabella), the nasolabial fold.

In the region of the bridge of the nose (glabella), the highest point of the fold is selected, 0.3 cm distal from it, a needle is inserted into the dermis, the volume of injection into the line of discrepancy is 0.1-0.3 ml of the drug, the line of discrepancy is determined by the individual anatomical features of the patient. After the procedure, the drug is distributed evenly by pressing on this area with the thumb of the right hand. Thus, the patient gets a natural look, minimal trauma and even distribution of the drug in the tissues, with a low risk of damage to the blood vessels of the nose. Perhaps the introduction of the drug using a cannula.

In the nasolabial zone, it is desirable to combine a fan, bolus and linear injection technique. First, the length of the nasolabial fold is estimated, then the needle is inserted into the deep dermis parallel to the course of the fold, either a bolus or a “fan” is made in the area of the wings of the nose, consisting of 3 beams to raise the folds, then it is easily stretched with 2 fingers, the volume of injection in the zone of entrapment, 0.2-0.4 ml of the drug. After filling the entrainment in the area of the wings of the nose, the drug is administered linearly retrograde in the direction of the fold, the volume of administration is 1.5-2.0 ml. After administration, a soft distribution of the drug in the tissues with the fingers of both hands is mandatory, with the capture of the surrounding areas of the lower third, this allows you to get a natural look of the fold, evenly distribute in case of excessive administration of the drug. Perhaps the introduction of the drug using a cannula.

- bolus

This technique is used on the oval of the face, on the cheekbones, and also in combination with other techniques in case of uneven fold depth.

When correcting the face oval, injections are carried out along the bone edge, perpendicularly, 0.2 ml per injection, the distance between injections is 2 cm. After administration by active pressing of the thumb, the drug is distributed in the soft tissues. This technique allows you to simulate the oval of the face without making it heavier, unlike synthesized fillers, which, due to hydrophilic properties, enhance swelling and create additional ptosis. It is possible to administer the drug using a cannula, which makes the procedure less traumatic.

On the cheekbones, a bolus technique is used. Neurovascular bundles are located in this area, and patient safety is the prerogative of the doctor. Bolus administration allows for minimal trauma. First, the zone is marked on the most protruding edge of the zygomatic bone, then the needle is installed perpendicular to the tissues, a puncture to the periosteum is made, for each bolus 0.2 ml of the drug. The distance between the boluses is 3 cm. After correction, a rigorous modeling of the zygomatic region, which allows you to distribute the drug evenly, in areas of tissue deficiency. Even less traumatic and safe is the cannula injection in the cheekbones and the middle third of the face, which allows you to evenly distribute the drug in the treated area.

Repeat procedures are possible with an interval of 2 weeks, for the best result it is recommended to perform 2-3 procedures with an interval of 3 weeks, depending on the severity of soft tissue deficiency. This technique allows you to achieve a prolonged effect for 3-4 months the natural look of the patient.

Thus, the achieved technical result is:

- in providing "stereo position" with layer-by-layer restoration of face and body tissues through the use of various forms of platelet autoplasma, the original features of their preparation and administration by exposure at the dermal, hypodermal and periosteal levels;

- in stimulating tissue regeneration due to the formation of a “fibrin biomatrix”, which provides the synthesis of new collagen fibers on it, as on a frame;

- to reduce the invasiveness of the intervention, to prevent complications caused by the use of “thick” needles, while increasing its anti-aging effect through the use of a drug that, due to its physicochemical properties (lower density), can be introduced through thin “atraumatic” needles and cannulas.

The method is as follows:

Conduct a course of three procedures. Immediately before each procedure, blood sampling is carried out in a volume of 9-36 ml, its single centrifugation with a centrifugal force of 1000G for 5 minutes to obtain the native form of TAP. To carry out the first two procedures, 4 ml of the obtained native form of TAP is taken in 4 sterile syringes, 1 ml in each syringe and placed in a thermostat at a temperature of 56 ° C and exposure for 5 minutes to obtain a fibrin form of TAP. After cooling down for 2 minutes, the fibrin form of TAP is mixed with 4 ml of the remaining native form of TAP through a connector, connecting each syringe with the fibrin form of TAP to a syringe with the native form of TAP and making 5-10 passes from one syringe to another. The resulting mixture is introduced into the upper layer of the dermis with a needle with a diameter of 30G, size 0.3 × 12 mm, or a cannula with a diameter of 25G × 50 mm long, papular, tubercle, or linear retrograde, fan, bolus mesotherapy techniques. For the third procedure, 4 ml of the obtained native form of TAP is taken into 4 sterile syringes, 1 ml in each syringe and placed in a thermostat at a temperature of 75-80 ° C and exposure for 10 minutes to obtain the protein form of TAP. After cooling for 2 minutes, syringes with a protein form of TAP are connected using a connector with an empty syringe and 10-15 passes from a syringe with a protein form to each empty syringe and vice versa. The introduction of the mixture is carried out in the deep layers of the dermis, in the hypodermis and on the periosteum by means of a cannula with a diameter of 22G, length 57 mm, linear-retrograde, fan or bolus technique. If necessary, repeat the course after 2 weeks.

1. A 64-year-old patient complains of dryness, decreased tonus of the skin of her face and neck, the severity of nasolabial folds and puppet wrinkles, purse-string wrinkles, and a general tired face. Previously, I did not contact the cosmetologist. From the anamnesis of 10 years of menopause Diagnosis: L 57.4 Senile atrophy (lethargy) of the skin.

The treatment was carried out: 2 procedures with the native form of TAP in combination with the fibrin form, 1 procedure with the protein form of TA (treatment temperature 80 degrees) with an interval of 1 time per week. The TAP protein modification was used to correct nasolabial folds and puppet wrinkles, periosteally to correct volumes of the middle third of the face with cannula technique.

During each procedure, local anesthesia (application) of the face was performed. The patient received venous blood in a volume of 18 ml, obtained after centrifugation of 8 ml of platelet autologous plasma. TAP from one tube (4 ml) was taken into a sterile 10 ml syringe. TAP from another tube was taken into a 4 sterile 2 ml syringe with a 1 ml luer-lock and placed in a thermostat, heated to 56 degrees for 5 minutes. After cooling in a sterile tray for 2 minutes, the native and fibrin forms of TAP were mixed through a connector, connecting each syringe with the fibrin form of TAP to the syringe with the native form of TAP and making 5-10 passes. Next, the resulting preparation was injected into the upper layer of the dermis of the face and neck using papular technique, as well as into the lower layer of the dermis and pancreas in a short linear technique.

In the third procedure, the patient received venous blood in a volume of 18 ml, obtained after centrifugation of 8 ml of platelet autologous plasma. 8 ml of syringes were collected in 1 ml of TAP each. Syringes were placed in a thermostat preheated to 80 degrees for 10 minutes. Further, after cooling in a sterile tray for 2 minutes, the drug was homogenized. To do this, a syringe with a protein form of TAP was connected using a connector with an empty syringe and 10-15 passes were made from one syringe to another. The drug was introduced in a linear retrograde technique through a 22G × 57 mm cannula into the nasolabial folds, in a volume of 1 ml each side and in the area of wrinkles, “puppets” in a volume of 1 ml on each side. In the fan technique above the upper lip, in a volume of 0.2 ml on each side, into the area of the deep chin wrinkle, 0.6 ml is also used in linear retrograde technique. In the region of the middle third of the face using a 22G × 57 mm cannula in a linear retrograde technique, 1.5 ml on each side. The total volume of the drug administered was 8 ml. After the introduction of active kneading of the drug in the tissues, cold.

After a course of procedures, the patient noted a decrease in the severity of the depth of the nasolabial folds and wrinkles - “puppets”, smoothing purse-string wrinkles and restoration of volumes in the middle third, as well as improving the color, tone and hydration of the skin of the face and neck.

2. A 54-year-old patient complained of flabbiness and wrinkling of the skin of the neck. Anamnesis: 4 years postmenopause. Diagnosis: L 57.4 Senile atrophy (lethargy) of the skin.

The treatment was carried out: 2 procedures with the native form of TAP in combination with the fibrin form, 1 procedure with the protein form of TAP (processing temperature 75 degrees) with an interval of 1 time per week.

During each procedure, local anesthesia (application) of the face was performed. The patient received venous blood in a volume of 18 ml, obtained after centrifugation of 8 ml of platelet autologous plasma. TAP from one tube (4 ml) was taken into a sterile 10 ml syringe. TAP from another tube was collected in 4 sterile 2 ml syringes with 1 ml luer-lock and placed in a thermostat, heated to 56 degrees for 5 minutes. After cooling in a sterile tray for 2 minutes, the native and fibrin forms of TAP were mixed through a connector, connecting each syringe with the fibrin form of TAP to the syringe with the native form of TAP and making 5-10 passes. Next, the resulting preparation was introduced into the upper layer of the neck dermis with papular technique, as well as into the lower layer of the dermis using a short-line reinforcing technique.

In the third procedure, the patient received venous blood in a volume of 18 ml, obtained after centrifugation of 8 ml of platelet autologous plasma. The contents of one tube were collected in four 2 ml syringes of 1 ml of TAP. Syringes were placed in a thermostat preheated to 75 degrees for 10 minutes. Further, after cooling in a sterile tray for 2 minutes, the drug was homogenized. To do this, a syringe with a protein form of TAP was connected using a connector with an empty syringe and 10-15 passes were made from one syringe to another. The drug was introduced in a linear retrograde technique through a 25G × 50 mm cannula to volumize horizontal neck wrinkles. The contents of another tube with a native form of TAP in the amount of 4 ml was collected in a sterile 5 ml syringe with a luer-lock and inserted into the upper layer of the neck skin dermis using a papule technique.

After a course of procedures, the patient noted a significant improvement in color, tone and moisture of the skin, smoothing wrinkles of the neck.

One of the leading concepts in modern medical cosmetology is the “stereo rejuvenation” method, when the appearance is improved due to the layer-by-layer restoration of face and body tissues. The use of fibrin and protein heat-treated forms of TAP separately or together with the native (thermally untreated) form of TAP allow you to work at the dermal, hypodermal and periosteal levels, providing the effect of stereo-rejuvenation of the tissues of the face and body.

The layered administration of fibrin and protein heat-treated forms of TAP alone or together with the native form of TAP can be used to treat patients with photoaging.

The combination of different forms of native and thermally processed TAPs may be the procedure of choice for patients with severe manifestations of chronological aging, as they often have concomitant somatic diseases and require a sufficient amount of material for correction. The use of autologous material minimizes possible adverse reactions. From one tube with sodium heparin, it is possible to obtain on average up to 4 ml of platelet autoplasma or its thermally modified forms, which makes it possible to use a sufficient amount of material for correction with minimal financial costs.

Thus, a combination of various modifications: the native form of TAP, its forms obtained by heat treatment in a thermostat, allows you to work in different layers of soft tissues of the face and body, taking into account the peculiarities of aging of each patient, to create individual programs of aesthetic correction, achieving the effect of stereo rejuvenation of tissues.

Claims (8)

1. A method for correcting age-related changes in the soft tissues of the face and / or body, including the procedure for introducing platelet autoplasma (TAP) into the tissues, characterized in that conduct a course of three procedures, immediately before each procedure, blood sampling is carried out in a volume of 9-36 ml, its single centrifugation with a centrifugal force of 1000 G for 5 minutes to obtain the native form of TAP, for the first two procedures, 4 ml of the obtained native form of TAP are taken in 4 sterile syringes, 1 ml in each syringe and placed in a thermostat at a temperature of 56 ° C and exposure for 5 minutes to obtain the fibrin form of TAP, after it has cooled down for 2 minutes, mix the fibrin form of TAP with 4 ml of the remaining native form of TAP through a connector, connecting each syringe with the fibrin form of TAP to a syringe with the native form of TAP and making 5-10 passes from one syringe to another, the mixture is introduced using mesotherapy techniques in the upper dermis 30G needle with diameter size 0,3 × 12 mm diameter or cannula 25G × 50 mm in length; for the third procedure, 4 ml of the obtained native form of TAP are taken in 4 sterile syringes, 1 ml in each syringe and placed in a thermostat at a temperature of 75-80 ° C and exposure for 10 minutes to obtain the protein form of TAP, after cooling for 2 minutes, the syringes TAP is connected to the protein form using the connector with an empty syringe and 10-15 passes are made from the syringe with the protein form into each empty syringe and vice versa, the mixture is introduced using mesotherapy techniques into the deep layers of the dermis, hypodermis and periosteum using m cannula with a diameter of 22G, length 57 mm. 2. The method according to p. 1, characterized in that for the introduction of the fibrin form of TAP, papular, tubercle, linear retrograde, fan or bolus mesotherapy techniques are used. 3. The method according to p. 1, characterized in that for the introduction of the protein form of TAP using a linear retrograde, fan or bolus mesotherapy technique. 4. The method according to p. 1, characterized in that the course is repeated after 2 weeks.