Healing Post-CO₂ Laser Using MTP Technology

Extracellular matrix (ECM)-based wound products have been part of the wound care practitioner’s toolkit for decades. Containing collagen, elastin, exosomes, growth factors, and a wide variety of other biomolecules, the ECM plays a key role in regeneration of damaged tissue. As such, medical products created from ECM have proven invaluable in the clinic on challenging wounds. However, ECM-based products are primarily in a sheet form which is not well suited to use in many aesthetic procedures. In this case report, a new ECM product in liquid form, Multi-Tissue Platform (MTP), was applied to two patients immediately after CO₂ laser resurfacing. Both patients experienced a dramatic improvement in both post-procedure pain and recovery time. This promising case report merits follow-up in the form of a prospective clinical study to further explore the potential of this material to manage recovery after CO₂ laser resurfacing or other aesthetic treatments requiring downtime.

CASE REPORT

Patient 1 was a 49-year-old Caucasian female with sensitive skin and pigmentation issues, Fitzpatrick type II (Figure 1 through Figure 3). Patient 2 was a 45-year-old Caucasian female with sensitive skin, Fitzpatrick type III (Figure 8 through Figure 10). Neither patient had a history of prior C)₂ laser resurfacing. Patients were treated on the face, neck, and arms with the Smartskin^®+ ablative skin resurfacing system (Cynosure Lutronic) with two passes per area using the settings outlined in Table 1. Immediately following the second pass on each section of skin, MTP was applied in a thin but complete layer on the treated area. A total of 3 mL (one full dose) was applied to the face, with a second 3-mL dose applied to the eyes and neck (1 mL and 2 mL, respectively). As a control, each patient had MTP applied to the treated section of their right upper arm, and comparable treatment to their left arm: exosomes for Patient 1 and platelet-rich plasma for Patient 2. The patients were instructed not to wash the MTP off for at least 24 hours, but misting with water to rehydrate the gel and cool the skin as needed was permitted.

Figures 1-3. Patient 1 was a 49-year-old Caucasian female with sensitive skin and pigmentation issues, Fitzpatrick type II

The recovery trajectory for the face and neck was highly similar with both patients. As shown in Figure 4 through Figure 7 and Figure 11 through Figure 14, we noted expected levels of erythema, edema, and scabbing on postoperative days (POD) 1 and 2. The outer dermal layers began to peel on POD 3 through 5, and by the 1-week follow-up visit, the skin was fully re-epithelialized and was mildly pink and sensitive, as expected for new, healthy tissue. Pain was quantified using a numeric rating scale (0-10). Patient 1 reported pain level 4 on the first evening, 2 on POD 1 and 2, and no pain but only itching reported for POD 3 through 5. Patient 2 reported pain levels to be highest on POD 2 and 3, rated at pain level 5, with no pain starting POD 5. Both patients reported 1 week of total downtime (returning to all normal activities after 1-week follow-up visit).

Figures 4-7 show expected levels of erythema, edema, and scabbing on postoperative days (POD) 1 and 2 on patient 1. edema, and scabbing on postoperative days (POD) 1 and 2.

As seen in Figure 15, there were notable differences in healing between the MTP-treated and control-treated arms of both patients. Patient 1 noted pain level 1 through POD 1 on the MTP-treated arm, and at the 1-week visit the skin was markedly pink with healthy new tissue, most scabbing had peeled off, and minor spots showed continued re-epithelialization. However, the exosome-treated arm had pain level 5-6 with “throbbing” and “oozing” noted by the patient, and significant areas of deep scabbing remaining at 1 week. Patient 2 reported “no pain, only tightness” on the MTP-treated arm, with pain level 5-6 on the PRP-treated arm and deep scabs remaining past the 1-week follow-up visit.

Figures 8-10. Patient 2 was a 45-year-old Caucasian female with sensitive skin, Fitzpatrick type III.

DISCUSSION

The ECM is the 3D support structure of tissues and organs in which the cells reside. Although varying in composition across tissue types, the ECM is largely made up of collagens (more than 90% in some tissues) and is therefore often thought of as a passive, physical structure. However, the ECM also contains a wealth of growth factors and other signaling molecules and plays a critical role in such diverse processes as cell migration, proliferation, differentiation, and apoptosis. Due to the function of these bioactive molecules, decellularized ECM-based medical products have been used for decades in surgical settings for advanced wound management and soft tissue regeneration in applications from traumatic volumetric tissue loss to hernia and even dura mater repair. However, efficacy varies widely with the tissue source (both animal and organ of origin) and processing of the material, and applications have been limited by the physical form of the material (typically a sheet). Recently, the development of the MTP technology has expanded the potential applications of ECM-based products and made them more viable to use in high-downtime aesthetic procedures.

Figures 11-14 show expected levels of erythema, edema, and scabbing on postoperative days (POD) 1 and 2 on patient 2.

MTP is made of ECM from multiple tissue types and is specifically designed to contain less collagen and more growth factors than other ECM products. It contains more than 500 unique peptides and includes collagen types I, II, IV, and V; elastin; fibronectin; fibroblast growth factor (FGF); vascular endothelial growth factor (VEGF); epidermal growth factor (EGF); and hyaluronic acid. Exosomes are quantified at a minimum 160 billion per dose. MTP is US Food and Drug Administration-cleared in two separate forms—powder (XCelliStem, Stemsys) and liquid (ReyaGel, ReyaMed)—for the management of a wide variety of applications, including but not limited to post-laser surgery, surgical wounds, donor sites/grafts, post-Mohs surgery, partial and full-thickness wounds, second-degree burns, and tunneled/undermined wounds.

Figures 15 shows notable differences in healing between the MTP-treated arms of both patients.

Our case report details an on-label example of one of the first known uses of liquid MTP for post-treatment recovery in aesthetics. The recovery trajectory of both patients demonstrates the potential for a dramatic reduction in downtime as well as post-procedure pain after CO₂ laser skin resurfacing by immediate post-procedure application of MTP.