Journal of Clinical Epidemiology and Toxicology Review Article Open Access Aesthetics in Geriatrics Using Plasma and Its Fractions in India Hemamalini Narasimhan1, Utkrist Lahoria2 and Dilip Kachhawa3* 1Resident Dermatology (final year Postgraduate), Dr.SN medical college & MDM hospital, Jodhpur, India 2Resident Dermatology, AIIMS Jodhpur, India 3Senior professor and head, Department of dermatology, MDM hospital, Jodhpur, India ABSTRACT Introduction: Geriatric aesthetics is an evolving branch of cosmetology with extensive research conducted to minimize the invasiveness, number of visits and safety of the proposed modality. In developing country, the adding burden of cost hinders the practical application of standard aesthetic procedures used elsewhere. Platelet-rich plasma is an autologous preparation that is utilized in various fields of regenerative medicine. Objectives: The fractions of plasma such as platelet-rich plasma, fibrin and fibrin matrix are reviewed in this article with our personal experience of plasma- fractions prepared in a resource-limited setting in geriatric aesthetics for various indications and the psychology of the geriatric patient is to be reviewed in the narration. Methods: Various articles were traditionally reviewed from the pubmed database regarding “cost-effective geriatric aesthetics”, “platelet-rich plasma in aging skin” and “psychology of aging”.The literature is analyzed with our discipline of technique and narrated after searching the literature. Results: We address the immense need for appropriate patient selection, analysis of motivation and evaluation of patient psyche, economy and expectations for an ethical geriatric aesthetic practice in a resource limited setting. We also recommend the change of nomenclature of Platelet-poor plasma to “Plasma beyond platelets” as the uses of plasma are multitudinous. Limitation: No qualititative analysis was done in the study. Conclusion: The practice of geriatric aesthetics in resource limited setting is meticulous and needs great dedication. *Corresponding author Dilip kachhawa, Senior Professor and Head, MDM Bungalow No 3, Outside Gate 3, MDM Campus, Shastri Nagar, Jodhpur, Code: 342003, India. E-mail: [email protected] Received: May 24, 2021; Accepted: May 27, 2021; Published: May 29, 2021 Keywords: Geriatric Aesthetics, Platelet-Rich Plasma, Plasma- PDGF- platelet derived growth factors Fractions PRF- platelet rich fibrin PRFM- platelet rich fibrin matrix Abbreviatons PRP- platelet rich plasma AGA- Androgenetic Alopecia P-PRP- pure-PRP Bcl-2- B cell Lymphoma protein 2 P-PRF- Pure PRF CaCl2- calcium chloride SVF- stromal vascular fraction CD- cluster differentiation RT-PCR- Real time polymerase chain reaction Co2- Carbon Dioxide VEGF- vascular endothelial growth factor COL1A1- genes for collagen 1 alpha 1 COL1A2- genes for collagen 1 alpha 2 Introduction FGF7- fibroblast growth factor 7 Epidemiology of geriatric group in India HIV- human Immuno-deficiency Virus The financial inequalities in India is a crisis for better living, LASIK- Laser-assisted in-situ keratomileusis besides the religious and cultural disparities. But, the land L-PRF- Leukocyte rich Platelet rich fibrin has an agreement in improvement, effort, and life. The six L-PRP- Leukocyte rich Platelet rich plasma low revenue Indian states Assam, Chhattisgarh, Nagaland, the MMP - matrix metalloprotease Madhya Pradesh, Odisha and Uttar Pradesh–are home to larger m-RNA- messenger ribonucleic acid protein than one-third of India’s residents. Selvaraj et al estimated NSAIDS- Non-steroidal Anti-infammatory drugs the economic misfortune to affordable medicines in India that J Clin Epid Toxic, 2021 Volume 2(2): 1-7 Citation: Hemamalini Narasimhan, Utkrist Lahoria, Dilip Kachhawa (2021) Aesthetics in Geriatrics Using Plasma and Its Fractions in India. Journal of Clinical Epidemiology and Toxicology. SRC/JCET-124. DOI: https://doi.org/10.47363/JCET/2021(2)116. dwindled from 31.2% to 8.9% for in-patient care and from 17.8% selection criteria based on standard textbook information and to 5.9% for out-patient care. Consequently, common people the technique of platelet-rich plasma was narratively reviewed. suffer due to the inequalities and diverge to the pharmaceuticals Most reviews had their narration of PRP preparation (n = 39) thereby, constrained to misguidance and poly-pharmacy [1]. and anti-aging effects documentation (n = 27). Only three decription matched the preparation method of our institution Current trends of geriatric aesthetics in India while all reviews had specified methods of describing objectives In the soaring covid19 pandemic, esthetics in this denomination and validation methods included information. The other aspect is a remote prerogative. Mac cullam et al, affirms the distress studied was the psychology of aging which was mentioned in of the geriatric community in India that, almost 75% of the eight articles and its inferences are reviewed. No statistical economically dependent old adults grieve from stress [3]. The analysis was done. geriatric population constitutes the group that desires aesthetic support of distinct varieties. The eminent victim of beauty Selection criteria was Queen Elizabeth 1 who is recognized for caking white 1. Study population must be above middle age of life lead makeup over her face to conceal the smallpox scars and 2. Studies on economical anti-aging modalities consequently suffered from lead toxicity. It is stated that she 3. Study must be on platelet rich plasma and its fractions lost her hair and teeth that she never viewed her in the mirror 4. Study on aging psychology and media thereafter stating that the need for better looks is not a current trend [2]. All studies that are not appropriate for selection were excluded. The confrontation of unrealistic community by dermatologists Methodology of Platelet rich plasma preparation and Moon light and Moon walk face of Michael Jackson stunned injection considered for review: every American youth in the last centenary and the sense of being privileged was related to having fair skin and good looks. In Inclusion criteria research by MacCallum and colleagues, the media’s projection 1. Geriatric population seeking aesthetic aid on “aging beauties” as somebody who has the frame of youthful 2. Hemodynamic stability women was connected with a disruption in eating attitudes in 3. Willing to participate women aged 30–65 [3]. Exclusion criteria 1. Unrealistic expectation Psychology of aging 2. Reluctance to follow-up Da Costa et al. mentions that “Elderly must learn to age” because 3. Other contra-indication for PRP such as platelet disorders Westernly culture is a youth-oriented pop culture, exploring and systemic co-morbidities. any possible means to preserve youth and giving elder people a more leisurely or dim trait including mass media programs that Preparation of PRP [16-20] wilfully magnifies this comprehension to their advantage [4,5]. Reviewing various techniques, there appears no definitive protocol for preparation nor the frequency of PRP sessions. Hardships in a resource impaired locale The interval and the follow-up also varied. We follow the double Botulinum toxin, threads, Lasers, and Fillers are the discussion spin process of PRP preparation in our discipline. The PRP will of the present around the globe. Unfortunately, any of these be formulated under the observation of professionals from the are exceeding the reach of the majority of the population blood transfusion unit. Following verbal and written consent, an seeking a permanent solution at an economical charge in a few 8.5 ml blood sample is withdrawn in an Acid Citrate Dextrose appointments. Also, storage of Botulinum toxin is an issue in a (ACD) vacutainer tube. The two spin technique consists of a government set-up and the demand for repeated injections can 1200 rpm soft spin for 8 minutes upon which the buffy coat and be hindering in a low source background [6,7]. supernatant plasma are separated. The separated deeper portion containing the buffy coat will undergo second centrifugation, at Objectives 2400 rpm called the hard spin for 4 minutes. The deeper layer To explain the cost-effectiveness of the platelet-rich plasma of second spun material will be counted for platelet score. therapy formulated in our hospital comparing with research data of the past to understand the differences and to evaluate Procedure of injection the pros and cons of our technique through a narrative review. Technique at our setting: One hour before the procedure, local anesthetic cream (2.5% lignocaine + 2.5 prilocaine) will be Methods applied over the region to be managed after excluding drug Methodolgy of Literature review allergy to lignocaine. The procured PRP will be shot by an intra- A literature analyses was done from the Pubmed database from dermal technique in which multiple small fractions are injected 2004- 2021 by searching the keywords based on MeSH terms in a linear pattern 1mm apart to cover the planned region. This is and the terms “plasma, platelet rich” showed two articles while done under aseptic care. The sum of sessions differs depending “platelet rich plasma and skin aging” showed four articles and on the initial examination of the patient and the disease treated. around 150 articles were found in the term “plasma” of which 20 articles were related to platelet rich plasma and 74 articles Results and Discussion were found based on the term “PRP” of which only 13 articles Aging gracefully does not imply to resemble 30