Survey among women using Botox, Filler, and plasma injections in Basrah

Objective. Cosmetic procedures are popular in the world and practiced by both male and female. The origin of Botox is botulinum toxin of Clostridium botulinum, two main commercial types of botulinum (A and B) have been used in cosmetic clinics. The present study studied the distribution of the women according to types of cosmetic procedures, age groups, marital status, job status, and their knowledge about these procedures and its side effects. Methods. A total of 100 women were included with age group between (≤30 - >30) years. 54 (54%) have obtained cosmetic procedures (Botox, Filler, and plasma injections) while 46 (46%) have not obtained any cosmetic procedure. Platelets rich plasma was done by cosmetic specialized physician in private cosmetic clinic by using (Regen Kit BCT A-PRP). Platelets count was done in private Hematology laboratory by specialized Hematology physician. The device used for platelet count was (System XS 500). Collected data was subjected to statistical analysis by using SPSS version 20. Results. 51.85% women obtained their cosmetic procedures at a doctor clinic, (37.04%) at a Beauty Salon, and (11.11%) at both doctor clinic and Beauty Salon. Women within age group (≤30), (12%) have Botox only, (20%) have Filler only, (20%) have plasma injections only, (32%) Botox and Filler, (16%) have Botox, Filler, and plasma injections. 24.14% of women within age group (> 30), have Botox only, (6.90%) have Filler only, (13.79%) have plasma injections only, (31.03%) Botox and Filler, (6.90%) have Botox and plasma in jections, (17.24%) have Botox, Filler, and plasma injections. Platelets count in PRP samples in stage 1 sample from woman no.1 was 373 × 10 9 /L, while in (stage 2) sample was 724 × 10 9 /L. Platelets count in whole blood of woman no.1 was (202 × 10 9 /L). Platelets count in stage 1 sample from woman no.2 was 413x 10 9 /L, while in (stage 2) sample was 808 × 10 9 /L, Platelets count in whole blood of woman no.1 was 320 × 10 9 /L. There was statistically significant increase in platelets count in stage 1 and stage 2 in both samples (P-value=0.05). Conclusions. Women within age group (≤30) prefer to do cosmetic treatment even if they do not need that. Many women have awareness and confidence in doing these cosmetic treatments in doctor clinic rather than beauty salon. PRP platelets count indicated that using (Regen Kit BCT A-PRP) was successful in obtaining concentrated PRP from woman’s blood sample, comparing with the normal platelets count in whole blood. Results also explained that increasing the speed and period of centrifugation in the method of (Regen Kit BCT A-PRP) might give high concentrate of PRP.


INTRODUCTION
Cosmetic procedures are popular in the world and practiced by both male and female.In Middle Eastern region especially areas concerning with religious lifestyle it is hard to find studies concerning cosmetic procedures, although many people attending cosmetic clinic [1].These procedures in general aim to enhance the person's physical appearance [2].Some people accept cosmetics procedures as an option to increase self-steam [3,4].The present study aimed to survey the knowledge and practice of three of most commonly used cosmetic procedures (Botox, Fillers, and platelet rich plasma (PRP) injections) among women in Basra.The origin of Botox is botulinum toxin of Clostridium botulinum, two main commercial types of botulinum (A and B) have been used in cosmetic clinics.Administration of Botox in small injections blocks nerve impulses leading to reduce specific muscle activity.It is used for treatment of muscular conditions, chronic migraine [5].Also it is used in cosmetic clinic to remove wrinkles [6].Dermal fillers are non-surgical, anti-aging procedure used to plump lips, fill hollow cheeks and reduce the signs of aging [7].Platelet-rich plasma (PRP) is an autologous concentration of platelets in small volume of plasma; platelets have growth factors which play a role in healing process [8], treatment of hair Loss [9], and aging skin [10,11].Many studies showed that women prefer cosmetic procedures more than men [2].Cosmetic treatment by Botox might cause many side effects like facial paralysis, double vision, eyelid droop, swelling, redness, and allergic reactions [12].Platelets-rich plasma used in cosmetic treatment since 1987, no major side effects have been reported [13][14][15][16].
The present study studied the distribution of the women according to types of cosmetic procedures, age groups, marital status, job status, and their knowledge about these procedures and its side effects.

METHOD
Individuals under study were asked to answer questions included.Collected data was subjected to statistical analysis by using SPSS version 20.

Method of obtaining Platelet-rich plasma
Regen Kit BCT A-PRP This method was done by cosmetic specialized physician in private cosmetic clinic.The Blister packs opened carefully and prepare the tubes for blood collection.Venous puncture using butterfly needle connected to the collection holder, waited until the blood collected in the flexible tube, under the yellow plastic section.The stopper of the Regen BCT and Regen AST tubes were pierced to full with the whole blood using the internal needle of collection system.The vacuum within the tubes enabled automatic collection of blood (8 ml).The tubes turned upside down several times carefully.Centrifugation was done in two stages, 1st stage 1200g for 7 minutes.The 2nd stage 1600g for 9 minutes.The blood was fractioned: RBCs were trapped under the gel, and cellular elements settled on the surface of the gel (Figure 1).The Regen BCT tubes inverted several times gently, processed to the re-suspension of the cellular deposit in supernatant about 4 ml of PRP obtained for each tube (Figure 2).

Method of counting the platelets in PRP
Platelets count in 1 ml of platelet-rich plasma was done in private Hematology laboratory by specialized Hematology physician.The device used for platelet count was (System XS 500).

Distribution of women obtaining cosmetic procedures according to treatment intervals
Figure 3 showed that out of 54, 40 (74.07%) were obtaining cosmetic procedures in an intervals of ≤6 months and 14 (25.93%) in an intervals of >6 months.

Distribution of women according to treatment duration
Figure 4 showed that out of 54, 26 (48.15%) were obtaining cosmetic procedures for ≤1 year and 28 (51.85%) for >1 year.
Distribution of women according to the place in which they obtained the cosmetic treatment Figure 5 showed that out of 54, 28 (51.85%)women obtained their cosmetic procedures at a doctor clinic, 20 (37.04%) at a Beauty Salon, and 6 (11.11%) at both doctor clinic and Beauty Salon.

Distribution of woman obtaining cosmetic procedures according to their information and side effects
Figure 6 showed that out of 54, 15 (27.78%) have some information about these cosmetic procedures and 39 (72.22%) have no information about these procedure.

Distribution of women obtaining cosmetic procedures according to marital status
Figure 7 showed that out of 54 women having cosmetic procedures, 37(68.52%)were married and 17 (31.48%)single.

Distribution of women having no cosmetic procedures according to their knowledge of these procedures
Table 3 showed the distribution of women having no cosmetic procedures, but have some information about these procedures.12 (63.16%)were within age group (≤30), 10 (37.04%) within age group (>30), 10 (35.71%) were married, 12 (66.67%)were single, 13 (56.52%)having job, 9 (64.29%) were students and no woman who have no job had any information about these procedures.
Distribution of women having no cosmetic procedures according to their knowledge of side effects 4 (21.05%) of the women who have no information about the side effects of these cosmetic procedures, were within age group (≤30), 6 (22.22%) within age group (>30), 7 (25%) were married, 3 (16.67%)were single, 8 (34.78%) having job, 2 (14.29%) were students and no woman who have no job had any information about the side effects of these procedures (Table 4).

Platelet count in whole blood and in PRP samples
Table 5 illustrate the reading of platelets count in PRP samples.Platelets count in stage 1 sample from woman no.1 was 373 × 10 9 /L, while in stage 2 sample was 724 × 10 9 /L, the mean of the two readings was (433 × 10 9 /L).Platelets count in whole blood of woman no.1 was (202 × 10 9 /L).Also results in Table 5 showed that platelets count in stage 1 sample from woman no.2 was 413 × 10 9 /L, while in stage 2 sample was 808 × 10 9 /L, the mean of the two readings was (513 × 10 9 /L).Platelets count in whole blood of woman no.2 was 320 × 10 9 /L.There was statistically significant increase in platelets count in stage 1 and stage 2 in both samples (P-value= 0.05).

Women have no cosmetic procedures N=46
Have some information about these procedures

DISCUSSION
Dermatology and health experts' opinion is that improving the diet can make the skin looks young and healthy.Omega-3, fruits, and many healthy foods delay the appearance of wrinkles in the skin.The increasing demands on obtaining cosmetic procedures all over the world and especially in Iraq encouraged us to do this study.2012 marked high number of cosmetic injections to date in United States, with 6.1 million injections [17].The results of present study showed that the frequency of women within age group (>30) having Botox cosmetic treatment only is higher than the frequency of women within age group (≤30), while the frequency of women within age group (≤30) having Filler cosmetic treatment only is higher than the frequency of women within age group (>30).Plasma injections cosmetic treatment was more frequent among women within the age group (≤30).These results indicated that women within age group (≤ 30) prefer to do cosmetic treatment even if they do not need that.We think that there are many factors related to their interest in cosmetic treatment such as media [18], low self-confidence, effect of friends or the family.The present study indicated that frequency of cosmetic treatment with Botox, Filler, and Plasma injections is higher in women having a job than the frequency of students and women having no job, the high income might be one of the reasons for this.Married women showed higher frequency (68.52%) than single women (31.48%).Also 74.07% of women were obtaining cosmetic procedures in intervals of ≤6 months while 25.93% in intervals of >6 months.These findings need attention to that point that frequent cosmetic procedures in intervals of ≤6 months might have adverse effects such as the development of antibodies to botulinum neurotoxins (Botox) [19].The frequency of women obtaining cosmetic treatment for >1 year was higher than those for ≤1 year.These findings indicated increasing of cosmetic procedures in Basrah recently.The data of the present study indicated that most of women (51.85%) obtained their cosmetic treatment in doctor clinic, 37.04% in beauty salon, and 11.11% in both doctor clinic and beauty salon.These results indicated the presence of awareness and confidence that doing these cosmetic treatments in doctor clinic is safer than beauty salon, because it is done with caution and with scientific biases.In some salons, women might be injected with inappropriate preparation of botulinum toxin for example and by untrained hands, leading to adverse and a dangerous ef- fects [20].Dermal filler considered as FAD approved cosmetic device and there are many researches for studying sterility of the dermal filler [21].The present study indicated that only 27.78% have some information about cosmetic treatment and its side effects, while 72.22% of women have no information about it.
It is very important for women obtaining cosmetic treatment to know more information and the side effects of these procedures in order to be aware about any adverse effect after these treatments [22].Women having no cosmetic procedures, but have some information about these procedures.had any information about the side effects of these procedures.We noticed from these results that most women having no job have no information about these cosmetic procedures.In addition to its usage in cosmetic procedures, PRP injection considered as an option to treat alopecia [23].In the present study we studied the platelets count in PRP samples.Although platelet count studied in only two women obtaining plasma injections in the present study, but the results of plasma injections indicated that using (Regen Kit BCT A-PRP) was successful in obtaining concentrated PRP from woman's blood sample, comparing with the normal platelets count in whole blood.There are many kits and devices for obtaining PRP with different ability to getting sufficient active platelets concentrations [24].Platelets count in stage 2 samples from both women was higher than stage 1 samples.There was statistically significant increase in platelets count in stage 1 and stage 2 in both samples (P-value=0.05).These results explain that increasing the speed and period of centrifugation might give high concentrate of PRP.Centrifugation process must be done with sterile conditions and avoid lysing or damaging platelets in order to get more benefits from the released platelets growth factors [24].

CONCLUSIONS
Women within age group (≤30) prefer to do cosmetic treatment even if they do not need that.Also results indicated the presence of awareness and confidence that doing these cosmetic treatments in doctor clinic is safer than beauty salon, because it is done with caution and with scientific biases.The results of PRP platelets count indicated that using (Regen Kit BCT A-PRP) was successful in obtaining concentrated PRP from woman's blood sample, comparing with the normal platelets count in whole blood.Results also explained that increasing the speed and period of centrifugation in the method of (Regen Kit BCT A-PRP) might give high concentrate of PRP.

Recommendations
It is very important for women obtaining cosmetic treatment to know more information and the side effects of these procedures in order to be aware about any adverse effect after these treatments.It is very important to know the best and safest kind of commercial Botox or filler before use.We think that it is important to test the viability and count of active platelets in the PRP specimen before injection.Further research should be done to know the future effects of these cosmetic treatments on the skin or tissues.

TABLE 1 .
Distribution of women obtaining cosmetic procedures according to age group

TABLE 2 .
Distribution of women obtaining cosmetic procedures according to job status

TABLE 4 .
Distribution of women having no cosmetic procedures according to their knowledge of side effects

TABLE 5 .
Platelet count in whole blood and in PRP samples