Yüz Gençleştirme

Background
A 35 year old female presented with persistent hypopigmentation. Delayed wound healing after a chemical peel in 1995 resulted in keloidal and hypertrophic scar formation with hypopigmentation on
the forehead and upper lip. Nineteen Erbium laser resurfacings were then conducted over the next 10 years. This reduced the hypertrophic scarring but did not diminish the patient’s hypopigmentation

In 2005 ReCell was considered because of the persistent areas of hypopigmentation, mainly on her upper lip, forehead and cheeks.
 
Treatment
Under intravenous sedative anaesthesia, the entire face including the ReCell recipient areas, was treated with Erbium laser resurfacing at 8 joules/cm2 per pulse with a 5mm spot size. Double overlapping passes
were performed on the entire face giving a total fluence at any one site of approx 48J. Four microns of ablation per Joule will ablate approx
180 to 200 microns of tissue.

Using plain lidocaine local anaesthetic, a 2cm2 split thickness skin biopsy was harvested from the right retroauricular area using a DermaBlade, and then processed using the ReCell system. The resultant cell
suspension was drizzled on the resurfaced skin in the areas of previous hypopigmentation. After this, low adherent dressings were applied to the recipient sites (Urgotul, Urgo) followed by an absorbent fibrous fleece
(Kaltostat, Convatec). The tertiary dressing was a full face mask (Exudry adult face dressing, Smith & Nephew).
 
Results
 
 
 
Results continued…
 

Dressings were removed on Day 5 and the patient was instructed to lightly cleanse the face and use Eucerin ointment liberally three times daily or as required until all scabbing had lifted.
Contrary to normal advice after laser resurfacing, the patient was instructed to attempt as much sun exposure as possible.
At 3 months, re-pigmentation had occurred on up to 90% of her forehead and right cheek area, and somewhat less on her upper lip.

Discussion

Hypopigmented scarring is reasonably refractory to treatment. The patient is unique in having gone through many resurfacing procedures without substantial change to her hypopigmentation. This time, resurfacing followed by the application of ReCell autologous cell suspension, with adequate postoperative sun exposure, was associated with a marked improvement in her pigmentation.
The ReCell cell suspension contains a mixture of keratinocytes, fibroblasts and melanocytes amongst others. The somewhat sparse supply of melanocytes in the suspension must first survive and multiply, perhaps with the aid of ultraviolet light stimulation, before eventual repigmentation shows itself clinically. Previous work has shown that autologous non-cultured cell preparations are able to repigment vitiliginous areas 1,2